Jeffrey L Gibson DO PC
Organization Active NPI Family Medicine Physician · Nowata, OK
NPI 1164555058 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1164555058
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 3261 (OK)
- Legal business name
- JEFFREY L GIBSON DO PC
- Practice address
- 307A S Locust St
Nowata, OK 74048-3622 - Phone
- (918) 273-2761
- Fax
- (918) 273-2753
- NPI assigned
- Mar 13, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Jeffrey Gibson, DO
- Title
- Owner
- Phone
- (918) 273-2761
Practitioners 3
-
Alfred Gartzke, PA-C
-
Debra Keith, PA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090323000051 | OK | Part B Supplier - Clinic/Group Practice | 1254498017 |
Receives reassigned benefits from 3 practitioners Practice locations: Nowata, OK |
National Provider Directory
Locations
307A S Locust St
Nowata, OK 74048
Phone (918) 273-2761
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 3261 | OK | Yes |
Addresses
Primary practice location
307A S Locust St
Nowata, OK 74048-3622
Mailing address
307A S Locust St
Nowata, OK 74048-3622
Phone (918) 273-2761
Other names
- jeff gibson do
Other providers in Nowata, OK
- Mikayla Jackson
- Robert Jackson
- Jane Phillips Nowata Health Center
- Jane Phillips Nowata Health Center
- Jane Phillips Nowata Hospital Inc
- Lillian Kay Johndrow
- Colton Ray Johnson
- Dakota Shaye Jones
- Debra Keith
- Damita Kennard
All providers in Nowata, OK · Family Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.