Individual
MR. JUSTIN R GIBB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1828 S MILLENIUM WAY, MERIDIAN, ID 83642-5036
(208) 381-0262
Mailing address
PO BOX 2263, IDAHO FALLS, ID 83403-2263
(208) 525-2090
(208) 523-8978
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
200860041CRNA
OR
367500000X
Certified Registered Nurse Anesthetist
RNA728
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023263894
—
ID
01
—
2701125
REGENCE
—
05
—
500603268
—
OR
01
—
P00725584
RAILROAD MEDICARE
—
Enumeration date
11/20/2008
Last updated
05/21/2025
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