Provider Demographics
NPI:1629012273
Name:GIBBS, SHARON JILL (MD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:JILL
Last Name:GIBBS
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:PO BOX 262409
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-2409
Mailing Address - Country:US
Mailing Address - Phone:972-608-5000
Mailing Address - Fax:972-608-5020
Practice Address - Street 1:2800 E HIGHWAY 114
Practice Address - Street 2:SUITE 220
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5304
Practice Address - Country:US
Practice Address - Phone:972-608-5000
Practice Address - Fax:972-608-5020
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5540T208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1454068-02Medicaid
TX8448B6Medicare PIN
TXH43567Medicare UPIN