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General NPI Number Information
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NPI Number | 1437577913
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Entity Type | Individual
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Provider Name | MICHAEL DAVID GIBBONEY DPM
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Gender | Male
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 05/13/2025
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Provider Practice Location Address
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Address Line | NAVY MEDICINE READINESS & TRAINING UNIT FORT WORTH 1711 DOOLITTLE AVE, NAS JRB FORT WORTH
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City | FORT WORTH
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State | TX
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Zip | 76127
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Country | US
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Telephone | 817-782-3660
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Fax |
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Provider Business Mailing Address
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Address Line | NAVY MEDICINE READINESS & TRAINING UNIT FORT WORTH 1711 DOOLITTLE AVE, NAS JRB FORT WORTH
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City | FORT WORTH
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State | TX
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Zip | 76127
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Country | US
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Telephone | 883-636-4318
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | SC006592
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC006592
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License Number State | PA
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