Basic Information
| Provider Information | |||||||||
| NPI: | 1710168026 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIBBONS | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 W. BANDERA RD | ||||||||
| Address2: | STE 9 | ||||||||
| City: | BEORNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8308161717 | ||||||||
| FaxNumber: | 8308162103 | ||||||||
| Practice Location | |||||||||
| Address1: | 403 W. BANDERA RD. | ||||||||
| Address2: | SUITE 9 | ||||||||
| City: | BOERNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8308161717 | ||||||||
| FaxNumber: | 8308162103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2007 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 67735 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.