Individual
CHARLES CLARENCE GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
253 COUNTY ROUTE 47, SARANAC LAKE, NY 12983-5403
(518) 891-2660
(518) 891-2663
Mailing address
PO BOX 890, SARANAC LAKE, NY 12983-0890
(518) 891-2660
(518) 891-2663
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
136590
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00602433
—
NY
01
—
136590-1
NYS WORKERS' COMP
NY
Enumeration date
01/23/2006
Last updated
07/08/2007
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