Individual
DR. MICHAEL L GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
505 S JOHN REDDITT DR, LUFKIN, TX 75904-3120
(936) 634-8311
Mailing address
PO BOX 952270, DALLAS, TX 75395-0001
(972) 715-5000
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
E7409
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135630513
—
TX
05
—
135630514
—
TX
05
—
135630515
—
TX
05
—
200281000A
—
OK
01
—
8BZ894
BCBS
TX
Enumeration date
07/15/2005
Last updated
08/09/2011
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