Basic Information
| Provider Information | |||||||||
| NPI: | 1083609606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIBSON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | LEONARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 576 | ||||||||
| Address2: | BAPTIST HEALTH CENTER - SNEAD | ||||||||
| City: | SNEAD | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359520576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054667114 | ||||||||
| FaxNumber: | 2054663350 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 MEDICAL ST | ||||||||
| Address2: | BAPTIST HEALTH CENTER - SNEAD | ||||||||
| City: | SNEAD | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054667114 | ||||||||
| FaxNumber: | 2054663350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 02/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 10779 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | 10779 | AL | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000085126 | 05 | AL | MEDICAID | 051010596 | 01 | AL | BCBS | OTHER | 051545973 | 01 | AL | BCBS | OTHER | 051085126 | 01 | AL | BLUE CROSS | OTHER | 051554534 | 05 | AL | MEDICAID | 051520363 | 01 | AL | BCBS | OTHER |