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General NPI Number Information
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NPI Number | 1841331162
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Entity Type | Organization
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Legal Business Name | JUSTIN FAMILY MEDICAL, PA
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 310 W 2ND ST
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City | JUSTIN
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State | TX
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Zip | 76247-5023
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Country | US
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Telephone | 940-648-9900
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Fax | 940-648-1600
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Provider Business Mailing Address
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Address Line | PO BOX 68
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City | JUSTIN
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State | TX
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Zip | 76247-0068
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Country | US
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Telephone | 940-648-9900
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Fax | 940-648-1600
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Authorized Official
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Title or Position | MD
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Name | DR. MARK E GIBBS
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Credential | MD
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Telephone | 940-648-9900
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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 | K2701
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License Number State | TX
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