MEDICARE: GEOFFREY D GIBSON DO

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RH0003X	Hematology & Oncology Physician	U1276	TX

General Provider Information

NPI Number	:	1366806234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEOFFREY D GIBSON DO

Provider Business Mailing Address
First Line	:	800 W MAGNOLIA AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4611
Country	:	US
Telephone Number	:	817-759-7000
Fax Number	:	817-759-7027

Provider Business Practice Location Address
First Line	:	3537 S INTERSTATE 35 E STE 111
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76210-6868
Country	:	US
Telephone Number	:	817-759-7000
Fax Number	:	817-759-7027

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	07/19/2023

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Directions to “ GEOFFREY D GIBSON DO” Practice Location

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