Provider Demographics
NPI:1386710903
Name:GIBBS, GERALD E (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:E
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 1:364 SE 8TH AVE
Mailing Address - Street 2:SUITE 108-A
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4253
Mailing Address - Country:US
Mailing Address - Phone:503-640-3687
Mailing Address - Fax:503-640-3688
Practice Address - Street 1:364 SE 8TH AVE
Practice Address - Street 2:SUITE 108-A
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4253
Practice Address - Country:US
Practice Address - Phone:503-640-3687
Practice Address - Fax:503-640-3688
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11852207RH0003X
ORMD11852207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00086741OtherRAILROAD MEDICARE
OR217646Medicaid
R118175OtherMEDICARE #
OR83844001OtherBCBS
OR83844001OtherBCBS
R117645Medicare ID - Type Unspecified