| Doctor Name: | MR. MICHAEL FRANK GIBSON |
| NPI Number: | 1013122548 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | 2668834405 |
| Business Practice Address: | 1355 North University Ave Suite 210 Provo, UT - 84604 |
| Business Phone Number: | 8013738930 |
| Business Fax Number: | 8013776811 |
| Mailing Address: | 1355 North University Ave, Suite 210 PROVO |
| State: | UT |
| Postal Code: | 84604 |
| Phone Number: | 8013738930 |
| Fax Number: | 8013776811 |
| NPI Enumeration Date: | 05/10/2007 |
| NPI Last Update Date: | 02/21/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 2668834405 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |