George W Gibson DO PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

5101006424 Issued in MI

Legal business name

GEORGE W GIBSON DO PC

Practice address

15201 W McNichols Rd
Detroit, MI 48235-3717

Phone

(313) 930-0242

Fax

(734) 451-0603

NPI assigned

Apr 13, 2012

Organization subpart

No

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

Authorized official

Name

George W Gibson, M.D

Title

Owner

Phone

(313) 930-0242

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1334275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334275200000",
    "number": "1912264045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15201 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482353717",
            "telephone_number": "313-930-0242",
            "fax_number": "734-451-0603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15201 W MCNICHOLS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482353717",
            "telephone_number": "313-930-0242",
            "fax_number": "734-451-0603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE W GIBSON DO PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-13",
        "last_updated": "2012-04-13",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "313-930-0242",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101006424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENDING",
            "identifier": "5101006424",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Detroit, MI
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 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.