Healthcare Provider Details

I. General information

NPI: 1235355488
Provider Name (Legal Business Name): AUBREY CLARK GIBBS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 CLARKSVILLE ST SUITE 100
PARIS TX
75460-8076
US

IV. Provider business mailing address

3150 CLARKSVILLE ST SUITE 100
PARIS TX
75460-8076
US

V. Phone/Fax

Practice location:
  • Phone: 903-782-9206
  • Fax: 903-783-7367
Mailing address:
  • Phone: 903-782-9206
  • Fax: 903-783-7367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN9553
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: