Basic Information
| Provider Information | |||||||||
| NPI: | 1407994429 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIBBS | ||||||||
| FirstName: | IRIS | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 875 BLAKE WILBUR DRIVE | ||||||||
| Address2: | ROOM G222A | ||||||||
| City: | STANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943055847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507236171 | ||||||||
| FaxNumber: | 6507258231 | ||||||||
| Practice Location | |||||||||
| Address1: | 875 BLAKE WILBUR DR | ||||||||
| Address2: | MC 5847 | ||||||||
| City: | PALO ALTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 943042205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6507236171 | ||||||||
| FaxNumber: | 6507258231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 12/12/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | A61589 | CA | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0203X | A61589 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00A615890 | 05 | CA | MEDICAID |