# ANTHONY CLARK GIBBS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1710457940
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 12362 | TX | Yes |

## Other

- **Enumeration date:** 11/30/2018
- **Last updated:** 07/20/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1P6578 | MEDICARE | — |
| 05 | — | PENDING | — | TX |
| 01 | — | Q00089709 | RR MEDICARE | — |