Individual
MADENA JANE GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1695 MOSES RD, RAYMOND, MS 39154-8766
(601) 857-8638
Mailing address
1695 MOSES RD, RAYMOND, MS 39154-8766
(601) 857-8638
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
07981
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07981
MS MEDICAL LICENSURE
MS
Enumeration date
07/27/2017
Last updated
07/21/2022
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