Individual
RANDEL GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
353 HIGHWAY 15 N, PONTOTOC, MS 38863
(662) 490-1985
(662) 490-1989
Mailing address
PO BOX 497, AUGUSTA, AR 72006-0497
(870) 347-2534
(870) 347-2023
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02027
KY
207Q00000X
Family Medicine Physician
Primary
19706
MS
Other
Enumeration date
05/23/2006
Last updated
08/07/2018
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