Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | R9065 | TX |
NPI | 1033599840 |
---|---|
Provider Name | Juliet Gibson |
First Address | Dallas, TX 75230-5826 |
Second Address | Carrollton, TX 75010-4604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2015 |
Last Update Date | 25/07/2019 |