Individual
JERRY GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
336072265
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021622840
BCBS
IL
01
—
0071648971
BCBS
IL
01
—
0081646688
BCBS
IL
Enumeration date
08/17/2006
Last updated
06/12/2012
Update your record
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