Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | P9353 | TX |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | P9353 | TX |
NPI | 1316264484 |
---|---|
Provider Name | Dr. Steven David Gibbons |
First Address | San Antonio, TX 78229-3931 |
Second Address | San Antonio, TX 78229-3931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2010 |
Last Update Date | 01/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
401330201 | (05) | TX |
401330202 | CSHCN (01) | TX |