Provider Demographics
NPI:1427489590
Name:GULFTON MED CLINIC
Entity type:Organization
Organization Name:GULFTON MED CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-981-6151
Mailing Address - Street 1:6306 GULFTON ST
Mailing Address - Street 2:101
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-1117
Mailing Address - Country:US
Mailing Address - Phone:713-981-6151
Mailing Address - Fax:832-433-7861
Practice Address - Street 1:6306 GULFTON ST
Practice Address - Street 2:101
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-1117
Practice Address - Country:US
Practice Address - Phone:713-981-6151
Practice Address - Fax:832-433-7861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6235174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty