Individual
MAYA JACKSON-GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-1220
Mailing address
240 E HURON ST STE 1-200, CHICAGO, IL 60611-2909
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MT225176
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/30/2017
Last updated
05/25/2022
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