Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 02003009A | IN |
Y | 207P00000X | Emergency Physician | 005432 | AZ |
NPI | 1194745885 |
---|---|
Provider Name | Dr. George Raymond Gibson III |
First Address | Austin, TX 78752-3825 |
Second Address | Austin, TX 78752-3825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 11/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005432 | MEDICAL LICENSE (01) | AZ |
P8586 | TEXAS MEDICAL BOARD (01) | TX |