Individual
JERRY DEAN GIBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4000 SPENCER HWY, PASADENA, TX 77504-1202
(713) 359-2000
(713) 359-1004
Mailing address
PO BOX 3945, DEPT 841, HOUSTON, TX 77253-3945
(281) 348-0426
(281) 348-0426
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G3391
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050068684
RAILROAD MEDICARE
TX
05
—
127968902
—
TX
01
—
82175F
BC/BS
TX
Enumeration date
06/28/2006
Last updated
01/13/2016
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