Provider Demographics
NPI:1306937891
Name:GIBBS, RICHARD BARTHOLOMEW (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BARTHOLOMEW
Last Name:GIBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-7241
Mailing Address - Country:US
Mailing Address - Phone:901-274-8668
Mailing Address - Fax:901-276-0711
Practice Address - Street 1:1215 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-7241
Practice Address - Country:US
Practice Address - Phone:901-274-8668
Practice Address - Fax:901-276-0711
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7152207NS0135X
MS06637207NS0135X
ARR-4673207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAG6742969OtherDEA
TN3159036Medicare PIN
TNB02753Medicare UPIN