Provider Demographics
NPI:1932100740
Name:KIMBERLIN, GIBSON DAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GIBSON
Middle Name:DAN
Last Name:KIMBERLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DANNY
Other - Middle Name:
Other - Last Name:KIMBERLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:300 HOSPITAL CIR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-5806
Mailing Address - Country:US
Mailing Address - Phone:731-642-0016
Mailing Address - Fax:731-642-0306
Practice Address - Street 1:300 HOSPITAL CIR
Practice Address - Street 2:SUITE 103
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-5806
Practice Address - Country:US
Practice Address - Phone:731-642-0016
Practice Address - Fax:731-642-0306
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20271207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3051209Medicaid
TN3051209Medicare PIN
TN3051209Medicaid