Individual
CHRISTOPHER FRANK GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 E HIGHLAND AVE, SUITE 251, SAN BERNARDINO, CA 92404-3803
(909) 881-1614
(909) 881-2711
Mailing address
401 E HIGHLAND AVE, SUITE 251, SAN BERNARDINO, CA 92404-3803
(909) 881-1614
(909) 881-2711
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G45993
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G459930
—
CA
01
—
00G459932
MEDICARE INDIVIDUAL PTAN
—
01
—
G45993
LICENSE
CA
01
—
ZZZ07161Z
MEDICARE GROUP PTAN
—
Enumeration date
07/11/2006
Last updated
05/28/2008
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