Provider Demographics
NPI:1184695918
Name:GIBSON, GREGORY L (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2168
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:3941 HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-8578
Practice Address - Country:US
Practice Address - Phone:864-560-3650
Practice Address - Fax:864-560-3675
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCSC22052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89063TUMedicaid
SCT62571Medicaid
NC89063TUMedicaid
SCG63200Medicare UPIN