| Entity Name: | GREGORY A. GIBSON, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 18 Sep 1995 (29 years ago) |
| Document Number: | P95000071692 |
| FEI/EIN Number | 593334518 |
| Address: | 301 HEALTH PARK BLVD., STE #322, ST. AUGUSTINE, FL, 32086 |
| Mail Address: | 301 HEALTH PARK BLVD., STE #322, ST. AUGUSTINE, FL, 32086 |
| ZIP code: | 32086 |
| County: | St. Johns |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1801072756 | 2008-01-10 | 2008-01-30 | 301 HEALTH PARK BLVD STE 322, SAINT AUGUSTINE, FL, 320865771, US | 301 HEALTH PARK BLVD STE 322, SAINT AUGUSTINE, FL, 320865771, US | |||||||||||||||||||||||||
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| Phone | +1 904-824-3777 |
| Fax | 9048246050 |
Authorized person
| Name | CINDY GIBSON |
| Role | OFFICE MANAGER |
| Phone | 9048243777 |
Taxonomy
| Taxonomy Code | 207RG0300X - Geriatric Medicine (Internal Medicine) Physician |
| License Number | ME0060293 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 12553 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BAILEY JOHN D | Agent | 780 NORTH PONCE DE LEON BLVD., ST. AUGUSTINE, FL, 32084 |
| Name | Role | Address |
|---|---|---|
| GIBSON GREGORY A | Secretary | 301 HEALTH PARK BLVD., SUITE 322, ST. AUGUSTINE, FL, 32086 |
| Name | Role | Address |
|---|---|---|
| GIBSON GREGORY A | President | 301 HEALTH PARK BLVD., SUITE 322, ST. AUGUSTINE, FL, 32086 |
| Name | Role | Address |
|---|---|---|
| GIBSON GREGORY A | Treasurer | 301 HEALTH PARK BLVD., SUITE 322, ST. AUGUSTINE, FL, 32086 |
| Name | Role | Address |
|---|---|---|
| GIBSON GREGORY A | Director | 301 HEALTH PARK BLVD., SUITE 322, ST. AUGUSTINE, FL, 32086 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
