Provider Demographics
NPI:1013932607
Name:GIBSON, GERALD P (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:P
Last Name:GIBSON
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 1:5907 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6124
Mailing Address - Country:US
Mailing Address - Phone:148-809-9652
Mailing Address - Fax:
Practice Address - Street 1:4438 S CLACK ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-3634
Practice Address - Country:US
Practice Address - Phone:325-704-4470
Practice Address - Fax:325-704-4485
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6050207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00257709OtherSHIELD/HMSA
HI57659801Medicaid
G67602Medicare UPIN
HI57659801Medicaid