Gibson Medical PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

GIBSON MEDICAL PA

Practice address

307 Alcazar St
St Augustine, FL 32080-3708

Phone

(904) 495-5269

NPI assigned

Oct 6, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Gregory Gibson, MD

Title

President

Phone

(904) 495-5269

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601942400000",
    "number": "1124625801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3123",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320853123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 ALCAZAR ST",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320803708",
            "telephone_number": "904-495-5269"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIBSON MEDICAL PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-06",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-495-5269",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Girish Vasant Ghade, M.D
• Linda G Giacobbe, LCSW
• Amber Lynn Giannotta, BA
• Molly Giannotta, MS, LMHC, NCC
• Tina Gibbs
• Alfea Renise Gibson, FNP-BC
• Amy Gibson
• Gregory Alan Gibson, MD
• Jax Gibson, PHARMD
• Austin Jeffrey Gillette, DO

• Internal Medicine Physician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.