Provider Demographics
NPI:1063421782
Name:GIBSON, JAMES H (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 29211
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9211
Mailing Address - Country:US
Mailing Address - Phone:602-273-6770
Mailing Address - Fax:888-975-1546
Practice Address - Street 1:1020 N SAN FRANCISCO ST
Practice Address - Street 2:STE 1000
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3281
Practice Address - Country:US
Practice Address - Phone:928-526-1112
Practice Address - Fax:928-714-9285
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2016-07-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ18919207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104696Medicaid
AZF27738Medicare UPIN