Provider Demographics
NPI:1780864074
Name:R. BARTHOLOMEW GIBBS MD PC
Entity Type:Organization
Organization Name:R. BARTHOLOMEW GIBBS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-274-8668
Mailing Address - Street 1:PO BOX 41059
Mailing Address - Street 2:DBA CENTER FOR DERMATOLOGY
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38174-1059
Mailing Address - Country:US
Mailing Address - Phone:901-274-8668
Mailing Address - Fax:
Practice Address - Street 1:1215 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7241
Practice Address - Country:US
Practice Address - Phone:901-274-8668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207NSOL35X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3379585Medicare PIN