Individual
DR. THOMAS L. GIBBON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
114 DOWNEY PL, CUBA, MO 65453-1640
(573) 885-3358
(573) 885-3361
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
106716
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080102906
RR MCR
MO
05
—
1811074461
—
MO
01
—
431560263
TRICARE
MO
Enumeration date
11/01/2006
Last updated
02/07/2014
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