Individual
JACKSON V GIBSON
Active
Individual
JACKSON V GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
27189
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401871
EVERCARE
NC
01
—
110081949
PALMETTO GBA PROVIDER#
NC
01
—
35323
BC/BS NC PROVIDER#
NC
01
—
80140
MEDCOST PROVIDER#
NC
05
—
8935323
—
NC
01
—
FH1000130
FIRSTCAROLINACARE PROV.#
NC
01
—
Q27189
SC MEDICAID PROVIDER#
SC
Enumeration date
06/16/2006
Last updated
03/17/2016
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