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Organization

EDWARD D. GIBSON JR MD PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. EDWARD D GIBSON MD (OWNER/ PHYSHIAN)
(850) 624-9634
Entity
Organization

Contact information

Practice address
1514 W 23RD ST STE A-4, PANAMA CITY, FL 32405-2905
(850) 624-9634
(850) 769-2366
Mailing address
12241 LYNDELL PLANTATION DR, PANAMA CITY BEACH, FL 32407-2617
(850) 624-9634
(850) 769-2366

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME11148
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
53278
BCBS OF FLORIDA
FL
05
56431100
FL
Enumeration date
01/20/2012
Last updated
01/20/2012
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