Individual
DOUGLAS W GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
263 FARMINGTON AVE, RADIOLOGY, FARMINGTON, CT 06030-2803
(860) 679-2784
(860) 679-4126
Mailing address
263 FARMINGTON AVE, PROVIDER ENROLLMENT, FARMINGTON, CT 06030-2212
(860) 679-7503
(860) 679-1610
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
017099
CT
2085R0202X
Diagnostic Radiology Physician
Primary
017099
CT
Other
Enumeration date
09/20/2005
Last updated
09/26/2022
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