Provider Demographics
NPI:1942398383
Name:GIBSON, DAVID KURT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KURT
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 S JONES BLVD STE 5729
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2623
Mailing Address - Country:US
Mailing Address - Phone:608-387-1819
Mailing Address - Fax:
Practice Address - Street 1:9500 HILLWOOD DR STE 140
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-0525
Practice Address - Country:US
Practice Address - Phone:725-235-7884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA919052084P0800X, 2084P0800X
HIMD135242084P0800X
NV132532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12099Medicaid
NDN720415Medicare PIN
NDN720414Medicare PIN
ND12099Medicaid
ND12099Medicaid