Individual
DR. MILES KENTON GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
92 JOE T PETTY DR, SUITE 300, RUSSELL SPRINGS, KY 42642-8543
(270) 866-7066
(270) 866-7068
Mailing address
92 JOE T. PETTEY DR., SUITE 300, RUSSELL SPRINGS, KY 42642
(270) 866-7066
(270) 866-7068
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22156
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64221567
—
KY
Enumeration date
01/30/2006
Last updated
07/08/2007
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