Individual
DR. LEO BERMAN GIBSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RETIRED
Contact information
Practice address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
(304) 414-4800
Mailing address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1256
WV
Other
Enumeration date
06/09/2005
Last updated
05/02/2022
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