Provider Demographics
NPI:1760451272
Name:GIBBS, DAVID H (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:GIBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6832
Mailing Address - Country:US
Mailing Address - Phone:803-648-1171
Mailing Address - Fax:803-648-1666
Practice Address - Street 1:410 UNIVERSITY PKWY
Practice Address - Street 2:SUITE 2100
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6832
Practice Address - Country:US
Practice Address - Phone:803-648-1171
Practice Address - Fax:803-648-1666
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC17174208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC171744Medicaid
SC171744Medicaid
SCE74485Medicare UPIN