Provider Demographics
NPI:1760450787
Name:GIBBONS, DEBRA T (RD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:T
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:M
Other - Last Name:TARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:171 MAIN STREET
Mailing Address - Street 2:CAPE COD HOSPITAL DIABETES OUTPATIENT DEPARTMENT
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-862-5118
Mailing Address - Fax:508-778-9250
Practice Address - Street 1:171 MAIN STREET
Practice Address - Street 2:CAPE COD HOSPITAL DIABETES OUTPATIENT DEPARTMENT
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-862-5118
Practice Address - Fax:508-778-9250
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA161133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
P48006Medicare UPIN
MT0090Medicare ID - Type Unspecified