Provider Demographics
NPI:1013068881
Name:GIBSON, MICHAEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4515 SOUTHLAKE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3319
Mailing Address - Country:US
Mailing Address - Phone:205-313-7246
Mailing Address - Fax:205-939-1911
Practice Address - Street 1:4515 SOUTHLAKE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3319
Practice Address - Country:US
Practice Address - Phone:205-313-7246
Practice Address - Fax:205-939-1911
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2017-10-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL17424207L00000X, 207LP2900X, 2081P2900X, 2084P2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
167883900OtherUS DEPT OF LABOR
AL20-00232OtherUNITED HEALTHCARE
AL529502690Medicaid
AL0510 25521OtherBLUECROSSBLUESHIELD AL
AL0510 25521OtherBLUECROSSBLUESHIELD AL
ALF63507Medicare UPIN