Individual
ALEAH PENDERGRAFF GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1640 FLOSSIE DR, GREENDALE, IN 47025-8424
(877) 670-7264
(812) 539-1824
Mailing address
PO BOX 635283, CINCINNATI, OH 45263-5283
(877) 670-7264
(812) 539-1824
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01062453A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200834290
—
IN
05
—
64126824
—
KY
01
—
P00370136
RR MEDICARE
IN
Enumeration date
08/28/2006
Last updated
02/08/2024
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