Individual
DR. LAWRENCE KAY GIBBON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
185 W 4TH AVENUE, SUITE B, POST FALLS, ID 83854-7298
(208) 773-1592
(208) 773-9764
Mailing address
185 W 4TH AVENUE, SUITE B, POST FALLS, ID 83854-7298
(208) 773-1592
(208) 773-9764
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M4193
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010006362
REGENCE BLUE SHIELD
ID
05
—
0007628
—
ID
01
—
080002699
RAILROAD MDC
ID
01
—
41939
BLUE CROSS
ID
Enumeration date
01/22/2007
Last updated
04/27/2009
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