Provider Demographics
NPI:1881783892
Name:GIBSON, DUANE DUKE (PA-C)
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:DUKE
Last Name:GIBSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 S. 50 E.
Mailing Address - Street 2:PO BOX 865
Mailing Address - City:COALVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84017
Mailing Address - Country:US
Mailing Address - Phone:435-336-4403
Mailing Address - Fax:
Practice Address - Street 1:250 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:NV
Practice Address - Zip Code:89316
Practice Address - Country:US
Practice Address - Phone:775-237-5313
Practice Address - Fax:775-237-5073
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4922994-1206363A00000X
NVPA1005363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA1005OtherPA LICENSE