MEDICARE: WILLIAM EDWARD GIBBONS M.D.

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	207VE0102X	Reproductive Endocrinology Physician	E0931	TX

General Provider Information

NPI Number	:	1669474359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM EDWARD GIBBONS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 4775
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77210-4775
Country	:	US
Telephone Number	:	713-798-5696
Fax Number	:	713-798-1144

Provider Business Practice Location Address
First Line	:	6620 MAIN ST
Second Line	:	SUITE 1450
City	:	HOUSTON
State	:	TX
Zip	:	77030-2348
Country	:	US
Telephone Number	:	713-798-7500
Fax Number	:	713-798-1251

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	11/04/2008

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