Healthcare Provider Details

I. General information

NPI: 1588676571
Provider Name (Legal Business Name): CECIL W GABY MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7303 ROGERS AVE SUITE 101
FORT SMITH AR
72903-4165
US

IV. Provider business mailing address

7303 ROGERS AVE SUITE 101
FORT SMITH AR
72903-4165
US

V. Phone/Fax

Practice location:
  • Phone: 479-452-7447
  • Fax: 479-452-6693
Mailing address:
  • Phone: 479-452-7447
  • Fax: 479-452-6693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMC-2382
License Number StateAR

VIII. Authorized Official

Name: MRS. MELLNIE ANN GABY
Title or Position: OFFICE MANAGER
Credential:
Phone: 479-452-7447