Provider Demographics
NPI:1447485156
Name:HUMBOLDT PHYSICIANS SURGERY AND LASER CENTER LLC
Entity type:Organization
Organization Name:HUMBOLDT PHYSICIANS SURGERY AND LASER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:1ST AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:N
Authorized Official - Last Name:GIBB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-443-9777
Mailing Address - Street 1:2840 O'NEIL LANE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4870
Mailing Address - Country:US
Mailing Address - Phone:707-443-9777
Mailing Address - Fax:707-445-1003
Practice Address - Street 1:3226 TIMBER FALL COURT
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4888
Practice Address - Country:US
Practice Address - Phone:707-443-9777
Practice Address - Fax:707-445-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery