Individual
CHAD MICHAEL GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8001 YOUREE DR STE 4007, SHREVEPORT, LA 71115-2302
(318) 212-3821
(318) 212-3825
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-8951
(318) 212-6752
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
311424
LA
207R00000X
Internal Medicine Physician
R9490
TX
Other
Enumeration date
06/09/2015
Last updated
04/17/2019
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