Provider Demographics
NPI:1235119470
Name:GIBBS, JERRY WINFIELD (MD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:WINFIELD
Last Name:GIBBS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3660
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:200 AVENUE F NE
Practice Address - Street 2:WINTER HAVEN HOSPITAL
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4131
Practice Address - Country:US
Practice Address - Phone:863-292-4202
Practice Address - Fax:863-292-4103
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2007-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME44690207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00062547Medicare PIN
FLD82652Medicare UPIN
FL96573SMedicare PIN