Provider Demographics
NPI:1700904406
Name:GIBSON, ROBERT RANDALL (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RANDALL
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14345 CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-6980
Mailing Address - Country:US
Mailing Address - Phone:907-952-2695
Mailing Address - Fax:
Practice Address - Street 1:14345 CANYON RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-6980
Practice Address - Country:US
Practice Address - Phone:907-952-2695
Practice Address - Fax:909-563-9795
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51581207Q00000X
CO29061207Q00000X
AK5493207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3965Medicaid
AKU56146Medicare UPIN
AK8EB631Medicare PIN