Provider Demographics
NPI:1356604144
Name:GIBBS, BROOKE BENSON (MD)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:BENSON
Last Name:GIBBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:DANIELLE
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-212-8080
Mailing Address - Fax:843-212-8081
Practice Address - Street 1:1112 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-7315
Practice Address - Country:US
Practice Address - Phone:843-212-8080
Practice Address - Fax:843-212-8081
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL34719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC34719OtherMEDICAL LICENSE