Provider Demographics
NPI:1629120761
Name:GIBSON, JILL (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:GIBSON
Suffix:
Gender:
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:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:719-463-5600
Mailing Address - Fax:719-538-2990
Practice Address - Street 1:1715 IRON HORSE DR STE 100
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-9617
Practice Address - Country:US
Practice Address - Phone:720-494-4700
Practice Address - Fax:720-494-4706
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0049086207RR0500X
CO49086207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47730072Medicaid
CO47730072Medicaid