Provider Demographics
NPI:1992770549
Name:GIBSON, EMILY POLIS (MD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:POLIS
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 BILL MCDONALD PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:360-650-3400
Mailing Address - Fax:360-650-3883
Practice Address - Street 1:2001 BILL MCDONALD PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-650-3400
Practice Address - Fax:360-650-3883
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA19415207Q00000X
WAMD00019415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8444101Medicaid
WA7244304OtherAETNA
WA8938897OtherL&I
WA110237172OtherRAILROAD MEDICARE
WA8872GIOtherREGENCE
WA8872GIOtherREGENCE