Individual
PAUL H GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11188 TESSON FERRY ROAD, SUITE 100, SAINT LOUIS, MO 63123
(314) 849-5300
(314) 849-2014
Mailing address
11188 TESSON FERRY RD, SUITE 100, SAINT LOUIS, MO 63123-6962
(314) 849-5300
(314) 849-2014
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
MDR8115
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060012489
RR MCR
—
01
—
100777
HEALTHLINK
—
05
—
201166410
—
MO
01
—
21837
BLUE SHIELD BLUE CHOICE
MO
01
—
2500159
UNITED HEALTH CARE
—
01
—
4061051
AETNA
—
01
—
42440
GROUP HEALTH PLAN
—
Enumeration date
08/19/2005
Last updated
08/30/2016
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