Individual
DR. MARK C. GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
054569
GA
208800000X
Urology Physician
2008-01266
NC
Other
Enumeration date
07/21/2005
Last updated
07/14/2011
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