Organization
DWAYNE L GIBBS MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DWAYNE L GIBBS M.D. (OWNER)
(505) 324-2098
Entity
Organization
Contact information
Practice address
630 W MAPLE ST, SUITE A, FARMINGTON, NM 87401-6113
(505) 324-2098
(505) 324-6454
Mailing address
PO BOX 1919, SUITE C, FARMINGTON, NM 87499-1919
(505) 324-2098
(505) 324-6454
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
91-205
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
53885
—
NM
Enumeration date
11/21/2008
Last updated
12/06/2012
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