Basic Information
| Provider Information | |||||||||
| NPI: | 1235656166 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIPSON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | LOUIS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | BASSETT ARMY COMMUNITY HOSPITAL | ||||||||
| Address2: | 1060 GAFFNEY RD #7440 | ||||||||
| City: | FORT WAINWRIGHT | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073615603 | ||||||||
| FaxNumber: | 9073614847 | ||||||||
| Practice Location | |||||||||
| Address1: | DDHC 3RD BDE SCMH | ||||||||
| Address2: | 683 WAIANAE AVE BLDG 677 | ||||||||
| City: | SCHOFIELD BARRACKS | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084338277 | ||||||||
| FaxNumber: | 8084338230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.