Individual
MR. RICHARD JOSEPH GIBAS SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DN
Contact information
Practice address
1408 ANTHONY DR, CHAMPAIGN, IL 61821-1149
(217) 351-4000
(217) 356-3991
Mailing address
1408 ANTHONY DR, CHAMPAIGN, IL 61821-1149
(217) 351-4000
(217) 356-3991
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01025336
BCBS OF IL
IL
Enumeration date
10/31/2006
Last updated
07/08/2007
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