Individual
BERNARD R GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 UNIVERSITY BLVD, MAIL ROUTE 783, GALVESTON, TX 77555-0783
(409) 772-1911
(409) 772-1943
Mailing address
301 UNIVERSITY BLVD, MAIL ROUTE 783, GALVESTON, TX 77555-0783
(409) 772-1911
(409) 772-1943
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
E1590
TX
207N00000X
Dermatology Physician
Primary
E1590
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356822357
—
TX
05
—
1674590-04
—
TX
05
—
1674590-05
—
TX
05
—
167459001
—
TX
Enumeration date
07/21/2005
Last updated
06/09/2021
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