Individual
DANIEL KENNETH GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
1875 INTERCOVE RD, BLDG 3813, VIRGINIA BEACH, VA 23459-8932
(757) 492-1708
(757) 492-1716
Mailing address
1875 INTERCOVE RD, BLDG 3813, VIRGINIA BEACH, VA 23459-8932
(757) 492-1708
(757) 492-1716
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
03/06/2012
Last updated
03/06/2012
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