Provider Demographics
NPI:1104811447
Name:GIBSON, JAMES BROWN (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BROWN
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1721 WESTON BRENT LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3013
Mailing Address - Country:US
Mailing Address - Phone:915-598-1448
Mailing Address - Fax:915-594-7456
Practice Address - Street 1:1721 WESTON BRENT LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3013
Practice Address - Country:US
Practice Address - Phone:915-598-1448
Practice Address - Fax:915-594-7456
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9657173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC16076Medicare UPIN