Healthcare Provider Details

I. General information

NPI: 1770784886
Provider Name (Legal Business Name): RUTHIE GIBSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 W BLOCK ST
EL DORADO AR
71730-5355
US

IV. Provider business mailing address

1207 W BLOCK ST
EL DORADO AR
71730-5355
US

V. Phone/Fax

Practice location:
  • Phone: 870-864-5133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: BOB WATSON
Title or Position: SUPERINDENT
Credential:
Phone: 870-864-5001