MEDICARE: KAREN L. GIBBONS MD

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	208000000X	Pediatrics Physician	J6959	TX

General Provider Information

NPI Number	:	1659377299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN L. GIBBONS MD

Provider Business Mailing Address
First Line	:	7922 EWING HALSELL DR
Second Line	:	SUITE 440
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3726
Country	:	US
Telephone Number	:	210-614-2500
Fax Number	:	210-614-2755

Provider Business Practice Location Address
First Line	:	7922 EWING HALSELL DR
Second Line	:	SUITE 440
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-3726
Country	:	US
Telephone Number	:	210-614-2500
Fax Number	:	210-614-2755

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	12/15/2011

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