Provider Demographics
NPI:1457353237
Name:GIBBS, TERRY M (DO)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:M
Last Name:GIBBS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SEAGATE STE 800
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1558
Mailing Address - Country:US
Mailing Address - Phone:419-824-5608
Mailing Address - Fax:419-882-3686
Practice Address - Street 1:5308 HARROUN RD
Practice Address - Street 2:STE 175
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2114
Practice Address - Country:US
Practice Address - Phone:419-824-5608
Practice Address - Fax:419-882-3686
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004072207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH22549OtherHPM
OH160041496OtherRRMC
OH07-01571OtherUHC
OH603738OtherFHP
OH2083354OtherAETNA
MI4206513Medicaid
OH000000141264OtherANTHEM
OH00255OtherPARAMOUNT
OH0652486Medicaid
MIOM35150Medicare ID - Type Unspecified
OH0652486Medicaid
OH000000141264OtherANTHEM