Basic Information
| Provider Information | |||||||||
| NPI: | 1881783892 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIBSON | ||||||||
| FirstName: | DUANE | ||||||||
| MiddleName: | DUKE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 142 S. 50 E. | ||||||||
| Address2: | PO BOX 865 | ||||||||
| City: | COALVILLE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4353364403 | ||||||||
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| Practice Location | |||||||||
| Address1: | 250 S. MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7752375313 | ||||||||
| FaxNumber: | 7752375073 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 05/31/2016 | ||||||||
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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 | 363A00000X | 4922994-1206 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PA1005 | 01 | NV | PA LICENSE | OTHER |