Individual
DR. SUSAN M GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3840 GAULT AVE N, FORT PAYNE, AL 35967-5211
(256) 844-4975
(256) 844-4978
Mailing address
309 TAYLOR ST, SCOTTSBORO, AL 35768-2421
(256) 259-5313
(256) 259-4923
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21115
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051544789
BLUE CROSS BLUE SHIELD
AL
01
—
051544790
BLUE CROSS BLUE SHIELD
AL
01
—
051544791
BLUE CROSS BLUE SHIELD
AL
01
—
051544792
BLUE CROSS BLUE SHIELD
AL
01
—
051544794
BLUE CROSS BLUE SHIELD
AL
01
—
051544795
BLUE CROSS BLUE SHIELD
AL
05
—
630302067
—
AL
05
—
630303067
—
AL
05
—
630306067
—
AL
05
—
630307067
—
AL
05
—
630308067
—
AL
05
—
630309067
—
AL
Enumeration date
08/21/2006
Last updated
07/20/2012
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