NPI 1619391802

Mark Gibson, CPO

Practitioner Prosthetist Tallahassee, FL

Practice location

Address: 3334 Capital Medical Blvd #400, Tallahassee, FL 32308-4470
Phone: (850) 877-8174
Fax: (850) 877-5636

Registered specialties (2)

Prosthetist Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 224P00000X Licence POR276 (FL)

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Orthotist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 222Z00000X Licence POR276 (FL)

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Registry record

NPI: 1619391802
Entity type: Individual
Sex (as registered): Male
NPI issued: 10 Feb 2014
Record last updated: 13 Nov 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.