Provider Demographics
NPI:1699748772
Name:GIBSON, DANIEL L (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:GIBSON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 1107
Mailing Address - Street 2:HEALTH BRANCH WEST
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65102-1107
Mailing Address - Country:US
Mailing Address - Phone:573-893-7848
Mailing Address - Fax:573-893-1984
Practice Address - Street 1:3308 W EDGEWOOD DR
Practice Address - Street 2:SUITE B
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-6891
Practice Address - Country:US
Practice Address - Phone:573-893-7848
Practice Address - Fax:573-893-1984
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2000169649207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
440546366OtherUNITED HEALTCARE
174322OtherBCBS
MO245920210Medicaid
2623345OtherCIGNA
534157OtherHEALTHLINK
P00026725OtherRR MEDICARE
H70166OtherMERCY
2095433OtherFIRST HEALTH
P00026725OtherRR MEDICARE
2095433OtherFIRST HEALTH