Individual
DR. JEREMY L. GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4150 CROSSPOINT BLVD, EDINBURG, TX 78539-1803
(956) 296-1960
(956) 296-2855
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
K9540
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1446577-01
—
TX
01
—
1446577-02
CSHCN
TX
01
—
370019198
RR/MEDICARE
TX
01
—
8B4705
BLUE SHIELD
TX
Enumeration date
03/25/2006
Last updated
09/28/2023
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