Provider Demographics
NPI:1679989420
Name:GIBB, ERI (DO)
Entity type:Individual
Prefix:
First Name:ERI
Middle Name:
Last Name:GIBB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8379 W SUNSET RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2243
Mailing Address - Country:US
Mailing Address - Phone:702-476-2595
Mailing Address - Fax:725-200-3244
Practice Address - Street 1:1321 S RAINBOW BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-9047
Practice Address - Country:US
Practice Address - Phone:702-476-2287
Practice Address - Fax:702-476-2035
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015791207Q00000X
NVDO2264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1679989420Medicaid
NV1679989420Medicaid