Provider Demographics
NPI:1063704641
Name:GIBBS, MICHAEL GALEN (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GALEN
Last Name:GIBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:219 NOGALES AVE STE F
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3848
Mailing Address - Country:US
Mailing Address - Phone:805-682-8153
Mailing Address - Fax:805-682-5585
Practice Address - Street 1:219 NOGALES AVE STE F
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3848
Practice Address - Country:US
Practice Address - Phone:805-682-8153
Practice Address - Fax:805-682-5585
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1365942084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology