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Individual

DR. ALFRED EARL GIBBONS JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M. D

Contact information

Practice address
3115 PINE AVE, SUITE 301, WACO, TX 76708-3247
(254) 756-7044
(254) 756-3779
Mailing address
3115 PINE AVE, SUITE 301, WACO, TX 76708-3247
(254) 756-7044
(254) 756-3779

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
E4846
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00T591
BLUE CROSS/BLUE SHIELD
TX
Enumeration date
08/30/2006
Last updated
07/08/2007
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