| Roger O. Gibson Md Pc | |
|
1374 Cordova Cv Suite 102 Germantown TN 38138-2200 | |
| (901) 751-0150 | |
| (901) 751-1419 |
| Full Name | Roger O. Gibson Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1374 Cordova Cv, Germantown, Tennessee |
| Authorized Official Name and Position | Roger O. Gibson (PRESIDENT) |
| Authorized Official Contact | 9017510150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Roger O. Gibson Md Pc 1374 Cordova Cv Suite 102 Germantown TN 38138-2200 Ph: (901) 751-0150 | Roger O. Gibson Md Pc 1374 Cordova Cv Suite 102 Germantown TN 38138-2200 Ph: (901) 751-0150 |
| NPI Number | 1386836062 |
|---|---|
| Provider Enumeration Date | 08/15/2007 |
| Last Update Date | 08/08/2014 |
| Medicare PECOS PAC ID | 2163611260 |
|---|---|
| Medicare Enrollment ID | O20110105000348 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386836062 | NPI | - | NPPES |
| 08560 | Other | MS | STATE OF MISSISSIPPI BOARD OF LICENSE REGISTRATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 10277 (Tennessee) | Primary |
| Provider Name | Roger Owens Gibson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1316930704 PECOS PAC ID: 3173712270 Enrollment ID: I20110105000333 |
| Provider Name | Gary E Meyerrose |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1801885280 PECOS PAC ID: 4981754793 Enrollment ID: I20170518000505 |
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