Provider Demographics
NPI:1780744623
Name:GIBSON, BRETT WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:WILLIAM
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1084
Mailing Address - Country:US
Mailing Address - Phone:267-424-8850
Mailing Address - Fax:215-538-7907
Practice Address - Street 1:1534 PARK AVE
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1084
Practice Address - Country:US
Practice Address - Phone:267-424-8850
Practice Address - Fax:215-538-7907
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425814207X00000X
IL036170051207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
50079088OtherCAPITAL BLUE CROSS
P00766890OtherRAILROAD MEDICARE
1988582OtherAETNA HMO
50079088OtherKEYSTONE HEALTH PLAN CENTRAL
823437OtherFIRST PRIORITY HEALTH
1572580OtherGATEWAY HEALTH PLAN
353026000OtherKEYSTONE HEALTH PLAN EAST
120040OtherGEISINGER HEALTH PLAN
2055773OtherHIGHMARK BLUE SHIELD
353026000OtherINDEPENDENCE BLUE CROSS
9155053OtherAETNA PPO
895790OtherHEALTH AMERICA/HEALTH ASSURANCE
2819837OtherUNITED HEALTHCARE
353026000OtherAMERIHEALTH
9155053OtherAETNA PPO