Healthcare Provider Details

I. General information

NPI: 1639467442
Provider Name (Legal Business Name): GORDON L. GIBSON, M. D., P. A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2011
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 RIDGEWAY SUITES A & B
HOT SPRINGS AR
71901-7157
US

IV. Provider business mailing address

PO BOX 1190
CONWAY AR
72033-1190
US

V. Phone/Fax

Practice location:
  • Phone: 501-321-0547
  • Fax: 501-321-0386
Mailing address:
  • Phone: 501-227-7499
  • Fax: 501-504-2404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC4484
License Number StateAR

VIII. Authorized Official

Name: MRS. KANDI M MCNEAL
Title or Position: OFFICE MANAGER
Credential:
Phone: 501-227-7499