Individual
MARK R. GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
80 MAHALANI ST, WAILUKU, HI 96793-2531
(808) 243-6000
Mailing address
80 MAHALANI ST, WAILUKU, HI 96793-2531
(808) 243-6000
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
227243
MA
2084N0400X
Neurology Physician
Primary
MD-17283
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2118815
—
MA
Enumeration date
07/17/2006
Last updated
05/26/2021
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