Individual
DR. JACOB B GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2350 MIAMI VALLEY DR STE 310, CENTERVILLE, OH 45459-4778
(937) 438-5216
(937) 438-5229
Mailing address
3170 KETTERING BLVD BLDG B, MORAINE, OH 45439-1924
(937) 991-3188
(937) 223-9811
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
34-00-8573
OH
207RC0000X
Cardiovascular Disease Physician
34.008573
OH
207RI0011X
Interventional Cardiology Physician
Primary
34008573
OH
207UN0901X
Nuclear Cardiology Physician
34008573
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2598836
—
OH
Enumeration date
07/27/2006
Last updated
03/22/2022
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