Gibson, Russell

Gibson, Russell is an individual health care provider with primary practice located at 129 Montgomery Ln , Maryville TN 37803-5649. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Gibson, Russell can be contacted via phone (865) 681-1224.

Contact Information

Primary practice address
129 Montgomery Ln Maryville TN 37803-5649
Phone: (865) 681-1224
Fax: (865) 681-5185
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD18195 Tennessee

Profile Details

NPI number 1821048638
LBN Legal business name Gibson, Russell
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821048638 NPPES
Tennessee Other 0119209 BLUE CROSS BLUE SHIELD

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