Provider Demographics
NPI:1982606943
Name:GIBSON, JEFFREY BROOKS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BROOKS
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 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:615-329-7878
Mailing Address - Fax:615-329-7899
Practice Address - Street 1:4230 HARDING PIKE STE 530
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2094
Practice Address - Country:US
Practice Address - Phone:615-329-7878
Practice Address - Fax:615-329-7899
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD30960208G00000X
TN30960208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3881790Medicaid
TN4061335OtherBCBS OF TN
TN143172OtherUNISON TENNCARE
TN26144OtherTLC TENNCARE
TN3881790Medicaid
TN143172OtherUNISON TENNCARE
TN3881790Medicaid
TN143172OtherUNISON TENNCARE
H78260Medicare UPIN