Healthcare Provider Details

I. General information

NPI: 1841402252
Provider Name (Legal Business Name): PAMELA GABORNI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 06/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 ROGERS AVE
FORT SMITH AR
72903-4100
US

IV. Provider business mailing address

7301 ROGERS AVE
FORT SMITH AR
72903-4100
US

V. Phone/Fax

Practice location:
  • Phone: 479-314-2755
  • Fax: 479-314-4678
Mailing address:
  • Phone: 479-314-2755
  • Fax: 479-314-4678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberE-5707
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: