Provider Demographics
NPI:1659565448
Name:MATTHEW P GIBBS, MD, PA
Entity Type:Organization
Organization Name:MATTHEW P GIBBS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-543-7000
Mailing Address - Street 1:12415 BANDERA RD
Mailing Address - Street 2:STE 112
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4265
Mailing Address - Country:US
Mailing Address - Phone:210-543-7000
Mailing Address - Fax:210-543-7001
Practice Address - Street 1:12415 BANDERA RD
Practice Address - Street 2:STE 112
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4265
Practice Address - Country:US
Practice Address - Phone:210-543-7000
Practice Address - Fax:210-543-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0090NJOtherBCBS
TX0090NJOtherBCBS