Individual
JAY B GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3051 E UNIVERSITY BLVD, ODESSA, TX 79762-7902
(432) 362-4376
(432) 362-6308
Mailing address
4222 WENDOVER AVE, STE 600, ODESSA, TX 79762-5983
(432) 552-5656
(432) 552-0992
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA06975
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA06975
TEXAS LICENSE
TX
Enumeration date
03/23/2011
Last updated
02/18/2016
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