MEDICARE: DONALD GIBSON II MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	H5209	TX

General Provider Information

NPI Number	:	1073892352
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD GIBSON II MD PA

Provider Business Mailing Address
First Line	:	6307 HIDDEN CREST WAY
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-5583
Country	:	US
Telephone Number	:	832-721-8015
Fax Number	:

Provider Business Practice Location Address
First Line	:	6833 W SAM HOUSTON PKWY S
Second Line	:	SUITE #107
City	:	HOUSTON
State	:	TX
Zip	:	77072-5248
Country	:	US
Telephone Number	:	713-936-1308
Fax Number	:	713-936-1307

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. DEE RIASCOS
Credential	:
Telephone Number	:	832-248-1994

Provider Enumeration Date	:	08/04/2011
Last Update Date	:	08/04/2011

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