Individual
DR. PETER DOUGLAS GIBBONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17 BELMONT AVE, BRATTLEBORO, VT 05301
(802) 257-0115
(802) 257-8849
Mailing address
17 BELMONT AVE., BRATTLEBORO, VT 05301
(802) 257-8360
(802) 257-8849
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
042-0004180
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00004779
BLUE SHIELD
VT
05
—
0004779
—
VT
01
—
03-0239725
COMMERCIAL
VT
Enumeration date
12/11/2006
Last updated
07/08/2007
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