Individual
MR. THEODORE DWAYNE GIBSON I
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
CST/CFA
Contact information
Practice address
1500 S LAKE PARK AVE, HOBART, IN 46342-6638
(219) 947-6425
(219) 947-6424
Mailing address
1671 RUBY CT, HOBART, IN 46342-6507
(219) 945-1572
(219) 945-1572
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
—
—
Other
Enumeration date
11/25/2005
Last updated
07/08/2007
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