Active NPI
Duane Duke Gibson, PA-C
- Physician Assistant
- Eureka, NV
National Provider Identifier
1881783892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 4922994-1206
- Practice address
- 250 S. Main Street
Eureka, NV 89316 - Phone
- (775) 237-5313
- Fax
- (775) 237-5073
- NPI assigned
- Oct 11, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 4922994-1206 | UT | Primary |
Addresses
Primary practice location
250 S. Main Street
Eureka, NV 89316
Mailing address
142 S. 50 E.
PO Box 865
Coalville, UT 84017
Phone (435) 336-4403
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA1005 | Other | NV | PA LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160729000360 | UT | Order and Referring Only - Physician Assistant | 0648270744 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4922994-1206 | UT | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1464652800000",
"number": "1881783892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "142 S. 50 E.",
"address_2": "PO BOX 865",
"city": "COALVILLE",
"state": "UT",
"postal_code": "84017",
"telephone_number": "435-336-4403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 S. MAIN STREET",
"city": "EUREKA",
"state": "NV",
"postal_code": "89316",
"telephone_number": "775-237-5313",
"fax_number": "775-237-5073"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "DUANE",
"middle_name": "DUKE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-11",
"last_updated": "2016-05-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": "4922994-1206",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA LICENSE",
"identifier": "PA1005",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Eureka, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.