Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jack Michael Gibson, MD

Individual provider Obstetrics & Gynecology Physician · NPI 1346235777

Jack Michael Gibson, MD is an Obstetrics/Gynecology in Peoria, Illinois. Qualified in 1981, 45 years ago. Practices with The Board of Trustees of the University of Illinois, a 1,142-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
45
Licensed in
IL
In the registry since
2005
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone: (309) 696-2297
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Obstetrics & Gynecology Physician (primary) Taxonomy 207V00000X · Licence 036064619 (IL)

Record details

NPI number1346235777
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedSeptember 12, 2005
Last updated in NPPESJuly 18, 2019
Mailing address530 Ne Glen Oak Ave, Peoria, IL 61637-0001

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOBSTETRICS/GYNECOLOGY
Medical schoolOTHER
Graduated 1981 (45 years in practice)
Group practice The Board Of Trustees Of The University Of Illinois — 1142 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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