MEDICARE: DR. JEAN-MARIE GIBSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	54021	TX

General Provider Information

NPI Number	:	1275992539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEAN-MARIE GIBSON

Provider Business Mailing Address
First Line	:	11658 N IH 35
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-5305
Country	:	US
Telephone Number	:	210-683-7337
Fax Number	:

Provider Business Practice Location Address
First Line	:	11658 N IH 35
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78233-5305
Country	:	US
Telephone Number	:	210-683-7337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	02/15/2016

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