Provider Demographics
NPI:1982764957
Name:GIBSON, TERRY (MHR)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 BUTLER DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-5059
Mailing Address - Country:US
Mailing Address - Phone:405-321-4679
Mailing Address - Fax:
Practice Address - Street 1:930 N FLOOD AVE
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-7642
Practice Address - Country:US
Practice Address - Phone:405-321-3719
Practice Address - Fax:405-364-3209
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator