Provider Demographics
NPI:1013971167
Name:GIBLIN, MARKHAM SCOTT (PHD)
Entity Type:Individual
Prefix:MR
First Name:MARKHAM
Middle Name:SCOTT
Last Name:GIBLIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 NW HARRISON BLVD
Mailing Address - Street 2:STE # 140
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5916
Mailing Address - Country:US
Mailing Address - Phone:541-738-6516
Mailing Address - Fax:541-738-6517
Practice Address - Street 1:1300 NW HARRISON BLVD
Practice Address - Street 2:STE # 140
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5916
Practice Address - Country:US
Practice Address - Phone:541-738-6516
Practice Address - Fax:541-738-6517
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR925103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R55537Medicare UPIN
OR115061Medicare ID - Type Unspecified