Provider Demographics
NPI:1720421878
Name:GIBSON, DREW DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:DAVID
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2393 H G MOSLEY PKWY
Mailing Address - Street 2:BLDG 4 SUITE 101
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-3665
Mailing Address - Country:US
Mailing Address - Phone:903-291-1667
Mailing Address - Fax:903-291-1792
Practice Address - Street 1:700 E. MARSHALL AVE
Practice Address - Street 2:GOOD SHEPHERD MEDICAL CENTER
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4000
Practice Address - Country:US
Practice Address - Phone:903-291-1667
Practice Address - Fax:903-291-1792
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ9357207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine