Provider Demographics
NPI:1457548430
Name:GIBSON, KERI LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:LOUISE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 W 2100 S
Mailing Address - Street 2:REDWOOD HEALTH CENTER
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-1401
Mailing Address - Country:US
Mailing Address - Phone:801-213-9900
Mailing Address - Fax:801-213-9185
Practice Address - Street 1:1525 W 2100 S
Practice Address - Street 2:REDWOOD HEALTH CENTER
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-1401
Practice Address - Country:US
Practice Address - Phone:801-213-9900
Practice Address - Fax:801-213-9185
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6359011-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology