Healthcare Provider Details

I. General information

NPI: 1376280701
Provider Name (Legal Business Name): RICKY L GABLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date: 07/07/2022
Reactivation Date: 08/23/2022

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

140 MILLHOUSE DR
MADISON MS
39110-6966
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5594
  • Fax:
Mailing address:
  • Phone: 870-740-9931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number73719
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: