Provider Demographics
NPI:1528160603
Name:GIBBY, GORDON L (MD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:L
Last Name:GIBBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GORDON
Other - Middle Name:LANE
Other - Last Name:GIBBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-392-3441
Practice Address - Fax:352-392-7026
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53013207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57909Medicare UPIN
FL68451ZMedicare PIN