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Individual

RICHARD F GIBSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
545 NE 47TH AVE, PORTLAND, OR 97213-2237
(503) 215-9700
(503) 215-9701
Mailing address
PO BOX 13994, PORTLAND, OR 97213-0994
(503) 215-6494
(203) 215-6644

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD19917
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
079884
OR
01
80120791
RR MEDICARE
OR
Enumeration date
06/03/2006
Last updated
06/03/2008
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