Provider Demographics
NPI:1073892352
Name:DONALD GIBSON II MD PA
Entity Type:Organization
Organization Name:DONALD GIBSON II MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIASCOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-248-1994
Mailing Address - Street 1:6307 HIDDEN CREST WAY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5583
Mailing Address - Country:US
Mailing Address - Phone:832-721-8015
Mailing Address - Fax:
Practice Address - Street 1:6833 W SAM HOUSTON PKWY S
Practice Address - Street 2:SUITE #107
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-5248
Practice Address - Country:US
Practice Address - Phone:713-936-1308
Practice Address - Fax:713-936-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5209207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty