Basic Information
| Provider Information | |||||||||
| NPI: | 1568627768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLAIBORN | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36000 DARNALL LOOP | ||||||||
| Address2: | CARL R. DARNALL ARMY MEDICAL CENTER | ||||||||
| City: | FT. HOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76544 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 36000 DARNALL LOOP | ||||||||
| Address2: | CARL R. DARNALL ARMY MEDICAL CENTER | ||||||||
| City: | FT. HOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2542888303 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2008 | ||||||||
| LastUpdateDate: | 11/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 4855 | OK | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | E-6899 | AR | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 2011-03-2943 | MO | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | P7893 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 51266 | 01 | ABEM CERTIFICATE NUMBER | OTHER |