Individual
KENNETH GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2431
(208) 750-7445
(208) 750-7395
Mailing address
415 6TH ST, LEWISTON, ID 83501
(208) 750-7445
(208) 750-7445
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
41676
KY
207RC0000X
Cardiovascular Disease Physician
ME44229
FL
207RI0011X
Interventional Cardiology Physician
2016035277
MO
207RI0011X
Interventional Cardiology Physician
Primary
M-12671
ID
207RI0011X
Interventional Cardiology Physician
ME44229
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005793300
—
FL
Enumeration date
11/21/2005
Last updated
09/10/2020
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