Gibson, Mark

Gibson, Mark is an individual health care provider with primary practice located at 3334 Capital Medical Blvd #400 , Tallahassee FL 32308-4470. He recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Prosthetist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthotist. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Prosthetist is his primary health care specialty. Gibson, Mark can be contacted via phone (850) 877-8174.

Contact Information

Primary practice address
3334 Capital Medical Blvd #400 Tallahassee FL 32308-4470
Phone: (850) 877-8174
Fax: (850) 877-5636
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Prosthetist 224P00000X POR276 Florida
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthotist 222Z00000X POR276 Florida

Profile Details

NPI number 1619391802
LBN Legal business name Gibson, Mark
Credentials CPO
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 10th, 2014
Last updated Nov 13th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1619391802 NPPES
Florida MEDICAID 951939400

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