Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1190 | TX |
N | 222Z00000X | Podiatrist | 1190 | TX |
Y | 224P00000X | Prosthetist | 1190 | TX |
NPI | 1164653390 |
---|---|
Provider Name | John W Gibson |
First Address | San Antonio, TX 78240-4718 |
Second Address | San Antonio, TX 78240-4718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2009 |
Last Update Date | 24/11/2014 |