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Individual

LARRY GIBSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2051 HAMILL RD, STE 301 B, HIXSON, TN 37343-6614
(423) 877-1212
Mailing address
2051 HAMILL RD SUITE 302, HIXSON, TN 37343
(423) 877-1212
(423) 877-6793

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD19747
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3074845
BLUECROSS BLUESHIELD
TN
05
3181502
TN
Enumeration date
10/04/2006
Last updated
09/02/2020
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