Provider Demographics
NPI:1750324836
Name:GIBSON, RAY NEIL (DO)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:NEIL
Last Name:GIBSON
Suffix:
Gender:M
Credentials:DO
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 2470
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:TX
Mailing Address - Zip Code:76430-8021
Mailing Address - Country:US
Mailing Address - Phone:325-762-3661
Mailing Address - Fax:325-762-3859
Practice Address - Street 1:450 KENSHALO ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:TX
Practice Address - Zip Code:76430
Practice Address - Country:US
Practice Address - Phone:325-762-3661
Practice Address - Fax:325-762-3859
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTXF9477207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10773554OtherCAQH CREDENTIALING
TX854650OtherUNITED HEALTH CARE
TXH08CL16101OtherBCBS
TX134935910Medicaid
TX121408OtherSUPERIOR