Gibson, Roger O.

Gibson, Roger O. is an individual health care provider with primary practice located at 1374 Cordova Cv Suite 102, Germantown TN 38138-2200. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Gibson, Roger O. can be contacted via phone (901) 751-0150.

Contact Information

Primary practice address
1374 Cordova Cv Suite 102 Germantown TN 38138-2200
Phone: (901) 751-0150
Fax: (901) 751-1419
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 10277 Tennessee

Profile Details

NPI number 1316930704
LBN Legal business name Gibson, Roger O.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 31st, 2005
Last updated Aug 30th, 2007 - about 18 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 1316930704 NPPES
Tennessee Other 10277 TN MEDICAL LICENSE
Tennessee Other 2006851 TN MEDICAL LICENSE
Tennessee MEDICAID 3382574 TN MEDICAL LICENSE
Tennessee Other 44D0314829 TN MEDICAL LICENSE

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