National Provider Identifier
Bryan R Gibb, PA-C
Bryan R Gibb, PA-C is listed in the NPPES registry with a primary specialty of Physician Assistant in Ithaca, NY and a listed phone number of (607) 272-7000.
Profile Overview
- NPI
- 1063014413
- Provider Type
- Individual
- Primary Specialty
- Physician Assistant
- Enumeration Date
- November 11, 2020
- Last Updated
- December 03, 2020
Practice Location
- 16 Brentwood Dr Ste A
- Ithaca, NY 14850-1863
Phone: (607) 272-7000
Mailing Address
- 690 Ridge RD Apt 201
- Lansing, NY 14882-8980
Specialties
- Physician Assistant (363A00000X)
Full Record
- NPI
- 1063014413
- Entity Type
- Individual
- Last Name
- Gibb
- First Name
- Bryan
- Middle Name
- R
- Name Prefix
- Mr.
- Credential
- PA-C
- Mailing Street Address
- 690 Ridge RD Apt 201
- Mailing City
- Lansing
- Mailing State
- NY
- Mailing ZIP Code
- 14882-8980
- Mailing Country
- US
- Mailing Phone
- (850) 368-1074
- Practice Street Address
- 16 Brentwood Dr Ste A
- Practice City
- Ithaca
- Practice State
- NY
- Practice ZIP Code
- 14850-1863
- Practice Country
- US
- Practice Phone
- (607) 272-7000
- Practice Fax
- (607) 272-4604
- Enumeration Date
- November 11, 2020
- Last Updated
- December 03, 2020
- Sex
- Male
- Sole Proprietor
- No
- Certification Date
- December 03, 2020
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Physician Assistant (363A00000X)