Individual
DR. RANDOLPH DOUGLAS GIBBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
91275 66TH AVE, SUITE 500, MECCA, CA 92254
(614) 659-0871
Mailing address
91275 66TH AVE, SUITE 500, MECCA, CA 92254
(760) 396-1249
Taxonomy
Speciality
Code
Description
License number
State
202C00000X
Independent Medical Examiner Physician
Primary
35046271
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0504029
—
OH
Enumeration date
06/20/2007
Last updated
01/13/2012
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