Provider Demographics
NPI:1003063785
Name:RAY N GIBSON, DO
Entity Type:Organization
Organization Name:RAY N GIBSON, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:N
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:325-823-3231
Mailing Address - Street 1:101 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:ANSON
Mailing Address - State:TX
Mailing Address - Zip Code:79501-2113
Mailing Address - Country:US
Mailing Address - Phone:325-823-3231
Mailing Address - Fax:325-823-3098
Practice Address - Street 1:101 AVENUE J
Practice Address - Street 2:
Practice Address - City:ANSON
Practice Address - State:TX
Practice Address - Zip Code:79501-2113
Practice Address - Country:US
Practice Address - Phone:325-823-3231
Practice Address - Fax:325-823-3098
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAY N GIBSON,DO LLC STAMFORD MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXF9477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113528104OtherFIRSTCARE
TX0046DFOtherBCBS
TX121408OtherSUPERIOR
TX134935901Medicaid
TXA66610Medicare UPIN
TX113528104OtherFIRSTCARE