Individual
DR. DANIEL PETER GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
333 N 1ST ST STE 250, BOISE, ID 83702-6132
(208) 381-9384
(208) 381-9385
Mailing address
13345 ILLINOIS ST, CARMEL, IN 46032-3318
(317) 396-1300
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
65310
WI
2085R0202X
Diagnostic Radiology Physician
65310
WI
2085R0204X
Vascular & Interventional Radiology Physician
65310
WI
2085R0204X
Vascular & Interventional Radiology Physician
Primary
M-17359
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M-17359
—
ID
05
—
Q006012
—
TN
Enumeration date
11/28/2006
Last updated
01/10/2024
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