Leon Wagner Gibble, MD
Individual provider Active NPI Internal Medicine Physician · Mount Wolf, PA
NPI 1720181894 · NPPES record last updated May 27, 2011
Key facts
- NPI
- 1720181894
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- MD024778E (PA)
- Practice address
- 44 North Fifth Street
Mount Wolf, PA 17347 - Phone
- (717) 266-3631
- Fax
- (717) 266-6751
- NPI assigned
- Sep 6, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD024778E | PA | MD | Internal Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD024778E | PA | Yes |
Addresses
Primary practice location
44 North Fifth Street
Mount Wolf, PA 17347
Mailing address
PO Box 846
44 North Fifth Street
Mount Wolf, PA 17347
Phone (717) 266-3631
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 194265 | Other | PA | BS |
| P00314888 | Other | PA | RAILROAD |
| 01713101 | Other | PA | BC |
Other providers in Mount Wolf, PA
- Christine Deerin
- Hali Dekker
- Elizabeth Dixon
- Allisen Eberly
- For Sleep Sake
- Keara Goodhart
- Nicole Joy Hardy
- George Warren Herrold
- Nancy L Herrold
- Juliana M Hickey
All providers in Mount Wolf, PA · Internal Medicine Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.