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Individual

DR. ELMER RICKEY GIBBS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
49 CLEVELAND ST 310, CROSSVILLE, TN 38555-2854
(931) 787-1232
(931) 787-1228
Mailing address
49 CLEVELAND ST 310, CROSSVILLE, TN 38555-2854
(931) 787-1232
(931) 787-1228

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
35733
TN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
35733
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
27-1779467
TAX ID
05
3382060
TN
01
4042486
TENNCARE SELECT NUMBER
TN
01
4252798
BC/BS OF TN
TN
Enumeration date
05/23/2005
Last updated
01/21/2016
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