# KERMIT DONALD GIBSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1083760649
- **Gender:** Man
- **Credential:** DO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 02080 | KY | — |
| 208D00000X | General Practice Physician | 02080 | KY | Yes |
| 261QP2300X | Primary Care Clinic/Center | 02080 | KY | — |

## Other

- **Enumeration date:** 01/26/2007
- **Last updated:** 10/31/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 112617 | FED BLACK LUNG | — |
| 01 | — | 1270152 | UMWA FUNDS | — |
| 05 | — | 64020803 | — | KY |