Individual
DR. RUSSELL GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
129 MONTGOMERY LN, MARYVILLE, TN 37803-5649
(865) 681-1224
(865) 681-5185
Mailing address
129 MONTGOMERY LN, MARYVILLE, TN 37803-5649
(865) 681-1224
(865) 681-5185
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD18195
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0119209
BLUE CROSS BLUE SHIELD
TN
Enumeration date
05/11/2006
Last updated
07/08/2007
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