Provider Demographics
NPI:1992009369
Name:GIBSON, DOUGLAS AARON
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:AARON
Last Name:GIBSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59247 ARMSTRONG CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:JACOBSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43933-9797
Mailing Address - Country:US
Mailing Address - Phone:740-213-5299
Mailing Address - Fax:
Practice Address - Street 1:59247 ARMSTRONG CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:JACOBSBURG
Practice Address - State:OH
Practice Address - Zip Code:43933-9797
Practice Address - Country:US
Practice Address - Phone:740-213-5299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-28
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.132225-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse