Provider Demographics
NPI:1750476255
Name:GIBSON, GEOFFREY JAMES (DO)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:JAMES
Last Name:GIBSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 INDIAN ROCKS ROAD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-1096
Mailing Address - Country:US
Mailing Address - Phone:727-430-5442
Mailing Address - Fax:727-399-9392
Practice Address - Street 1:2025 INDIAN ROCKS ROAD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1096
Practice Address - Country:US
Practice Address - Phone:727-430-5442
Practice Address - Fax:727-399-9392
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-0006669208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
F72879Medicare UPIN
80854Medicare PIN