Individual
MARK GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
3334 CAPITAL MEDICAL BLVD #400, TALLAHASSEE, FL 32308-4470
(850) 877-8174
(850) 877-5636
Mailing address
3334 CAPITAL MEDICAL BLVD #400, TALLAHASSEE, FL 32308-4470
(850) 877-8174
(850) 877-5636
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
POR276
FL
224P00000X
Prosthetist
Primary
POR276
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
951939400
—
FL
Enumeration date
02/10/2014
Last updated
11/13/2014
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