MEDICARE: DR. GIBSON ANUGWOM 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	2084P0800X	Psychiatry Physician	V5967	TX

General Provider Information

NPI Number	:	1962144337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GIBSON ANUGWOM MD

Provider Business Mailing Address
First Line	:	1 BAYLOR PLZ
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-3411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3120 SOUTHWEST FWY STE 617
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77098-4521
Country	:	US
Telephone Number	:	832-637-6403
Fax Number	:	832-300-8990

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

Provider Enumeration Date	:	04/07/2022
Last Update Date	:	04/13/2026

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