Provider Demographics
NPI:1902814916
Name:GIBSON, SHARI LYNN (MD)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:LYNN
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5111 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-7075
Mailing Address - Country:US
Mailing Address - Phone:480-656-7654
Mailing Address - Fax:480-656-8718
Practice Address - Street 1:5111 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-7075
Practice Address - Country:US
Practice Address - Phone:480-656-7654
Practice Address - Fax:480-656-8718
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ17146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0252830OtherBCBS OF ARIZONA
AZ2239489OtherCIGNA HEALTH CARE
AZ2239489OtherCIGNA HEALTH CARE
AZAZ0252830OtherBCBS OF ARIZONA