Individual
ANTHONY CLARK GIBBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1320 WONDER WORLD DR STE 101, SAN MARCOS, TX 78666-7558
(512) 396-3911
(512) 353-0807
Mailing address
1320 WONDER WORLD DR STE 101, SAN MARCOS, TX 78666-7558
(512) 396-3911
(512) 353-0807
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12362
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1P6578
MEDICARE
—
05
—
PENDING
—
TX
01
—
Q00089709
RR MEDICARE
—
Enumeration date
11/30/2018
Last updated
07/20/2021
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