Provider Demographics
NPI:1972573269
Name:GIBSON, DANA LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:LYNN
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:202 LIMESTONE ST S STE 1A
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4320
Practice Address - Country:US
Practice Address - Phone:502-223-8400
Practice Address - Fax:502-875-3073
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY25301208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64253016Medicaid
KY64253016Medicaid