Individual
DR. ROGER O. GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
295 GERMANTOWN BEND CV, CORDOVA, TN 38018-7238
(901) 751-0150
(901) 695-2007
Mailing address
295 GERMANTOWN BEND CV, CORDOVA, TN 38018-7238
(901) 751-0150
(901) 695-2007
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
10277
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10277
TN MEDICAL LICENSE
TN
01
—
2006851
BLUE CROSS OF TENNESSEE
TN
05
—
3382574
—
TN
01
—
44D0314829
CLIA
TN
Enumeration date
08/31/2005
Last updated
11/15/2024
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