Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0202X | Pediatric Cardiologist | MD071808L | PA |
Y | 2080P0202X | Pediatric Cardiologist | N3669 | TX |
NPI | 1093775017 |
---|---|
Provider Name | Dr. Candace L Gibbin |
First Address | Dallas, TX 75390-9063 |
Second Address | Dallas, TX 75390-9063 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 04/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0018146860012 | (05) | PA |
0018146860013 | (05) | PA |
H26984 | (02) | PA |
MD071808L | MEDICAL LICENSE NUMBER (01) | PA |
N3669 | MEDICAL LICENSE NUMBER (01) | TX |