Individual
JENNIFER M. GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
37913
IA
208VP0000X
Pain Medicine Physician
37913
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144299900
MN MEDICAID
IA
05
—
1144299900
—
IA
Enumeration date
03/15/2006
Last updated
03/27/2013
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