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Individual
ANTHONY CLARK GIBBS
Active
Individual
ANTHONY CLARK GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12362
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1P6578
MEDICARE
—
05
—
PENDING
—
TX
01
—
Q00089709
RR MEDICARE
—
Enumeration date
11/30/2018
Last updated
07/20/2021
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