Individual
GREGORY ALAN GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 HEALTH PARK BLVD, SUITE 5008, SAINT AUGUSTINE, FL 32086-3707
(904) 824-3777
(904) 824-6050
Mailing address
PO BOX 3123, SAINT AUGUSTINE, FL 32085-3123
(904) 824-3777
(904) 824-6050
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
ME0060293
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12553
BLUE CROSS BLUE SHIELD
FL
01
—
P01087699
RAILROAD MEDICARE
FL
Enumeration date
08/09/2006
Last updated
03/31/2015
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