Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | R5119 | TX |
NPI | 1053672675 |
---|---|
Provider Name | Dr. Randolph Douglas Gibbs II |
First Address | Bryan, TX 77802-3478 |
Second Address | Bryan, TX 77802-3478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2012 |
Last Update Date | 18/05/2021 |