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General NPI Number Information
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NPI Number | 1659565448
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Entity Type | Organization
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Legal Business Name | MATTHEW P GIBBS, MD, PA
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 03/15/2011
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Provider Practice Location Address
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Address Line | 12415 BANDERA RD STE 112
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City | HELOTES
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State | TX
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Zip | 78023-4265
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Country | US
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Telephone | 210-543-7000
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Fax | 210-543-7001
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Provider Business Mailing Address
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Address Line | 12415 BANDERA RD STE 112
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City | HELOTES
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State | TX
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Zip | 78023-4265
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Country | US
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Telephone | 210-543-7000
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Fax | 210-543-7001
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Authorized Official
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Title or Position | PRESIDENT / CEO
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Name | MATTHEW PAUL GIBBS
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Credential | M.D.
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Telephone | 210-543-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | L0197
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License Number State | TX
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