Provider Demographics
NPI:1831129360
Name:GIBSON, JANET (DO)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 N PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5323
Mailing Address - Country:US
Mailing Address - Phone:850-513-0067
Mailing Address - Fax:850-561-6670
Practice Address - Street 1:1626 N PLAZA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5323
Practice Address - Country:US
Practice Address - Phone:850-513-0067
Practice Address - Fax:850-561-6670
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251553900Medicaid
FL251553900Medicaid
FLF16850Medicare UPIN