Healthcare Provider Details

I. General information

NPI: 1437577913
Provider Name (Legal Business Name): MICHAEL DAVID GIBBONEY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 05/13/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVY MEDICINE READINESS & TRAINING UNIT FORT WORTH 1711 DOOLITTLE AVE, NAS JRB FORT WORTH
FORT WORTH TX
76127
US

IV. Provider business mailing address

NAVY MEDICINE READINESS & TRAINING UNIT FORT WORTH 1711 DOOLITTLE AVE, NAS JRB FORT WORTH
FORT WORTH TX
76127
US

V. Phone/Fax

Practice location:
  • Phone: 817-782-3660
  • Fax:
Mailing address:
  • Phone: 883-636-4318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC006592
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC006592
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: