Individual
KYLE GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5409 AVENUE O, FORT MADISON, IA 52627-9601
(319) 376-1135
Mailing address
10050 S ROUTE N, COLUMBIA, MO 65203-8998
(573) 808-0722
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
087297
IA
Other
Enumeration date
04/27/2017
Last updated
04/27/2017
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