Individual
MICHAEL J GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
100 MCDOUGAL DR, HOLDENVILLE, OK 74848-2822
(405) 379-4202
(405) 379-4340
Mailing address
100 MCDOUGAL DR, HOLDENVILLE, OK 74848-2822
(405) 379-4202
(405) 379-4340
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
199
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0784740001
DMERC REGION C
—
05
—
100848080A
—
OK
01
—
P00266954
PALMETTO GBA RAILROAD MC
—
Enumeration date
06/27/2006
Last updated
10/17/2011
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