Individual
BRENT RANDALL GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
3851 ROGER BROOKE DR, FORT SAM HOUSTON, TX 78234-4501
(210) 916-2460
Mailing address
261 E OAKVIEW PL, SAN ANTONIO, TX 78209-3307
(870) 413-0525
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
#01056435A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467421669
—
MO
01
—
431560263
TRICARE WEST
—
Enumeration date
03/17/2006
Last updated
10/28/2008
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