Provider Demographics
NPI:1780877597
Name:GIBBONS, MAUREEN PATRICIA (MD)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:PATRICIA
Last Name:GIBBONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:PATRICIA
Other - Last Name:TORSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9113
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77387-9113
Mailing Address - Country:US
Mailing Address - Phone:941-200-0909
Mailing Address - Fax:
Practice Address - Street 1:1790 HUGHES LANDING BLVD STE 400
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1691
Practice Address - Country:US
Practice Address - Phone:941-200-0909
Practice Address - Fax:936-309-0309
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1331207P00000X
FLTRN9822390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX204823301Medicaid
TX1780877597OtherTRICARE SOUTH
TX1780877597OtherBCBSTX
TX204823302Medicaid
TX8L15633Medicare PIN
TX1780877597OtherBCBSTX
TX1780877597OtherTRICARE SOUTH