Provider Demographics
NPI:1043326366
Name:GIBBS, ROBERT LR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LR
Last Name:GIBBS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:24325 CRENSHAW BLVD
Mailing Address - Street 2:# 283
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5349
Mailing Address - Country:US
Mailing Address - Phone:424-777-6642
Mailing Address - Fax:877-223-4535
Practice Address - Street 1:24325 CRENSHAW BLVD
Practice Address - Street 2:# 283
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5349
Practice Address - Country:US
Practice Address - Phone:424-777-6642
Practice Address - Fax:877-223-4535
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA73898207P00000X, 208600000X
CAA73989174H00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No174H00000XOther Service ProvidersHealth Educator
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1093019036OtherNPI GROUP