NPIMap

Organization Active NPI

Dwayne L Gibbs MD PC

  • Surgery Physician
  • Farmington, NM
National Provider Identifier
1245485994
Registry record updated Dec 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
91-205 Issued in NM
Legal business name
DWAYNE L GIBBS MD PC
Practice address
630 W Maple St
Suite a
Farmington, NM 87401-6113
Phone
(505) 324-2098
Fax
(505) 324-6454
NPI assigned
Nov 21, 2008
Last updated
Dec 6, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2012

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

Authorized official

Name
Dr. Dwayne L Gibbs, M.D.NPI 1316073141
Title
Owner
Phone
(505) 324-2098

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 91-205 NM Primary

Addresses

Primary practice location

630 W Maple St
Suite a
Farmington, NM 87401-6113

Mailing address

PO Box 1919
Suite C
Farmington, NM 87499-1919
Phone (505) 324-2098

Other identifiers 1

IdentifierTypeStateIssuer
53885MedicaidNM

National Provider Directory

National Provider Directory

Locations

630 W Maple St
Ste A
Farmington, NM 87401
Phone (505) 324-2098

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1227225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354752000000",
    "number": "1245485994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1919",
            "address_2": "SUITE C",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874991919",
            "telephone_number": "505-324-2098",
            "fax_number": "505-324-6454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 W MAPLE ST",
            "address_2": "SUITE A",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874016113",
            "telephone_number": "505-324-2098",
            "fax_number": "505-324-6454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DWAYNE L GIBBS MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-21",
        "last_updated": "2012-12-06",
        "status": "A",
        "authorized_official_last_name": "GIBBS",
        "authorized_official_first_name": "DWAYNE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-324-2098",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "NM",
            "license": "91-205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "53885",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; 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.