Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1066 | TX |
N | 222Z00000X | Podiatrist | 1066 | TX |
Y | 224P00000X | Prosthetist | 1066 | TX |
NPI | 1063643294 |
---|---|
Provider Name | Pamela J Gibson |
First Address | Galveston, TX 77550-5505 |
Second Address | Galveston, TX 77550-5505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2009 |
Last Update Date | 05/08/2009 |