Provider Demographics
NPI:1093093833
Name:GIBSON, LESLEY DAVIS (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:DAVIS
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 GREENHOUSE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7857
Mailing Address - Country:US
Mailing Address - Phone:281-492-7676
Mailing Address - Fax:281-492-8133
Practice Address - Street 1:2051 GREENHOUSE RD STE 120
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-7857
Practice Address - Country:US
Practice Address - Phone:281-492-7676
Practice Address - Fax:281-492-8133
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0367208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1093093833OtherNPI
TX291323804Medicaid