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Individual
JOHNNY LEWIS GIBSON
Active
Individual
JOHNNY LEWIS GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
202C00000X
Independent Medical Examiner Physician
Primary
013131
LA
208600000X
Surgery Physician
MD.013132
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1301973
—
LA
Enumeration date
06/27/2007
Last updated
09/25/2019
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