Provider Demographics
NPI:1487692034
Name:GIBBY, DIANE L (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:L
Last Name:GIBBY
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Gender:F
Credentials:MD
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Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:C-820
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-6477
Mailing Address - Fax:972-566-6198
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:C-820
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-6477
Practice Address - Fax:972-566-6198
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
TXH2126208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC16075Medicare UPIN