Individual
MR. ALLEN WAYNE GIBSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
701 8TH AVE NW, SUITE A, ABERDEEN, SD 57401-1803
(605) 226-2663
(605) 226-0095
Mailing address
PO BOX 1474, ABERDEEN, SD 57402-1474
(605) 226-2663
(605) 226-0095
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0350
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6825710
—
SD
Enumeration date
07/29/2005
Last updated
07/08/2007
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