Edward D. Gibson Jr MD PA

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME11148 Issued in FL

Legal business name

EDWARD D. GIBSON JR MD PA

Practice address

1514 W 23Rd St Ste a-4
Panama City, FL 32405-2905

Phone

(850) 624-9634

Fax

(850) 769-2366

NPI assigned

Jan 20, 2012

Organization subpart

No

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

Authorized official

Name

Mr. Edward D Gibson, MD

Title

Owner/ Physhian

Phone

(850) 624-9634

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1327017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327017600000",
    "number": "1245501378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12241 LYNDELL PLANTATION DR",
            "city": "PANAMA CITY BEACH",
            "state": "FL",
            "postal_code": "324072617",
            "telephone_number": "850-624-9634",
            "fax_number": "850-769-2366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 W 23RD ST STE A-4",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324052905",
            "telephone_number": "850-624-9634",
            "fax_number": "850-769-2366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD D. GIBSON JR MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-20",
        "last_updated": "2012-01-20",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/ PHYSHIAN",
        "authorized_official_telephone_number": "850-624-9634",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME11148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FLORIDA",
            "identifier": "53278",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "56431100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychiatry Physician in Panama City, FL
• Providers in Panama City, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 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.