Provider Demographics
NPI:1881797439
Name:GIBSON, DON A (MD)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:A
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 180165
Mailing Address - Street 2:811 HWY 49 SOUTH
Mailing Address - City:RICHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:39218
Mailing Address - Country:US
Mailing Address - Phone:601-932-5060
Mailing Address - Fax:601-932-5062
Practice Address - Street 1:811 HWY 49 SOUTH
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MS
Practice Address - Zip Code:39218
Practice Address - Country:US
Practice Address - Phone:601-932-5060
Practice Address - Fax:601-932-5062
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS07980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0116314Medicaid
D73529Medicare UPIN
MS080004336Medicare PIN