Individual
STACEY LUCIA GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
234 STATE ST, BREWER, ME 04412-1519
(207) 989-0550
Mailing address
43 WHITING HILL RD, SUITE 300, BREWER, ME 04412-1005
(207) 973-5035
(207) 973-5042
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD21840
ME
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/27/2014
Last updated
03/17/2018
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