| Doctor Name: | DR. PATRICK JOHN GIBBONS |
| NPI Number: | 1336142124 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 0101229755 |
| Business Practice Address: | 13700 St Francis Blvd Suite 500 Midlothian, VA - 231143222 |
| Business Phone Number: | 8043787443 |
| Business Fax Number: | 8043780744 |
| Mailing Address: | Po Box 8310, ROANOKE |
| State: | VA |
| Postal Code: | 240140310 |
| Phone Number: | 5403453556 |
| Fax Number: | 5403422193 |
| NPI Enumeration Date: | 05/24/2005 |
| NPI Last Update Date: | 08/31/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 0101229755 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |