Active NPI
Mary Gibbons
- Family Medicine Physician
- Olympia, WA
National Provider Identifier
1710378229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD 00024037
- Practice address
- 7040 Puget Beach Rd NE
Olympia, WA 98516-9158 - Phone
- (360) 456-6971
- NPI assigned
- Feb 5, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD 00024037 | WA | Primary |
Addresses
Primary practice location
7040 Puget Beach Rd NE
Olympia, WA 98516-9158
Mailing address
7040 Puget Beach Rd NE
Olympia, WA 98516-9158
Phone (360) 456-6971
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD 00024037 | WA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1423094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1423094400000",
"number": "1710378229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7040 PUGET BEACH RD NE",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985169158",
"telephone_number": "360-456-6971"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7040 PUGET BEACH RD NE",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985169158",
"telephone_number": "360-456-6971"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBBONS",
"first_name": "MARY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-02-05",
"last_updated": "2015-02-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD 00024037",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.