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General NPI Number Information
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NPI Number | 1093019036
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Entity Type | Organization
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Legal Business Name | ROBERT L.R. GIBBS, MD - INCORPORATED
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 01/19/2011
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Provider Practice Location Address
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Address Line | 15338 FLORWOOD AVE
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City | LAWNDALE
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State | CA
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Zip | 90260-2327
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Country | US
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Telephone | 877-611-2112
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Fax | 877-469-2111
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Provider Business Mailing Address
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Address Line | PO BOX 91554
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City | LOS ANGELES
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State | CA
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Zip | 90009-1554
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Country | US
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Telephone | 877-611-2112
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Fax | 877-469-2111
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Authorized Official
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Title or Position | CEO/MEDICAL DIRECTOR
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Name | DR. ROBERT LEE ROOSEVELT GIBBS
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Credential | MD
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Telephone | 877-611-2112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A73989
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A73989
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A73989
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A73898
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License Number State | CA
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