Individual
PATRICK R. GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, MHP
Contact information
Practice address
ENFIELD MEDICAL ASSOCIATES, 701 ENFIELD STREET, ENFIELD, CT 06082
(860) 741-6058
(413) 733-5860
Mailing address
2150 MAIN STREET, SPRINGFIELD, MA 01104
(413) 739-5676
(413) 733-5860
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
510
MA
363A00000X
Physician Assistant
Primary
5858
CT
363A00000X
Physician Assistant
PA510
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110165973A
—
MA
Enumeration date
07/28/2006
Last updated
11/21/2022
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