Individual
DR. DIANE L GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6565 FANNIN ST STE B452, HOUSTON, TX 77030-2703
(713) 441-2677
(713) 790-2082
Mailing address
6565 FANNIN ST STE B452, HOUSTON, TX 77030-2703
(713) 441-3620
(713) 790-2082
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
H2400
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133957408
—
TX
05
—
2100599
—
LA
01
—
8AA440
BLUE CROSS PROVIDER ID
TX
01
—
P00416914
RR MEDICARE
—
Enumeration date
02/07/2007
Last updated
04/29/2010
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