Individual
JOHNNY LEWIS GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8030 CROWDER BLVD STE A, NEW ORLEANS, LA 70127-1063
(504) 246-2119
(504) 246-0663
Mailing address
1631 ELYSIAN FIELDS AVE, PO BOX 125, NEW ORLEANS, LA 70117-8208
(504) 246-2119
(504) 246-0663
Taxonomy
Speciality
Code
Description
License number
State
202C00000X
Independent Medical Examiner Physician
Primary
013131
LA
208600000X
Surgery Physician
MD.013132
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1301973
—
LA
Enumeration date
06/27/2007
Last updated
09/25/2019
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