Provider Demographics
NPI:1568564094
Name:GIBBS, M KELSEY (MD)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:KELSEY
Last Name:GIBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2870 LEWIS LN
Mailing Address - Street 2:SUITE 227
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-9379
Mailing Address - Country:US
Mailing Address - Phone:903-784-3326
Mailing Address - Fax:903-737-0840
Practice Address - Street 1:2870 LEWIS LN
Practice Address - Street 2:SUITE 227
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9379
Practice Address - Country:US
Practice Address - Phone:903-784-3326
Practice Address - Fax:903-737-0840
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD8231208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4355846OtherAETNA
TX00EC95OtherBLUE CROSS BLUE SHIELD
TX0329625-01Medicaid
TX0329625-01Medicaid
TXB22964Medicare UPIN