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General NPI Number Information
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NPI Number | 1952815748
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Entity Type | Individual
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Provider Name | MR. LARRY HIRIAM GIBSON JR.
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Gender | Male
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Dates
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Enumeration Date | 12/01/2017
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Last Update Date | 12/01/2017
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Provider Practice Location Address
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Address Line | 12925 NORTHWEST FWY
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City | HOUSTON
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State | TX
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Zip | 77040-6303
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Country | US
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Telephone | 364-254-8571
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Fax | 364-254-8571
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Provider Business Mailing Address
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Address Line | 12925 NORTHWEST FWY # 137
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City | HOUSTON
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State | TX
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Zip | 77040-6303
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Country | US
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Telephone | 346-254-8571
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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