Individual
DANIEL L GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3308 W EDGEWOOD DR, SUITE B, JEFFERSON CITY, MO 65109-6891
(573) 893-7848
(573) 893-1984
Mailing address
PO BOX 1107, HEALTH BRANCH WEST, JEFFERSON CITY, MO 65102-1107
(573) 893-7848
(573) 893-1984
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2000169649
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
174322
BCBS
—
01
—
2095433
FIRST HEALTH
—
05
—
245920210
—
MO
01
—
2623345
CIGNA
—
01
—
440546366
UNITED HEALTCARE
—
01
—
534157
HEALTHLINK
—
01
—
H70166
MERCY
—
01
—
P00026725
RR MEDICARE
—
Enumeration date
02/09/2006
Last updated
06/28/2012
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