Provider Demographics
NPI:1730150574
Name:GIBSON, WILLIAM ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALLEN
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18105 BEARGRASS CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4416
Mailing Address - Country:US
Mailing Address - Phone:210-493-6489
Mailing Address - Fax:
Practice Address - Street 1:18105 BEARGRASS CT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4416
Practice Address - Country:US
Practice Address - Phone:210-493-6489
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4391207P00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics