Provider Demographics
NPI:1093019036
Name:ROBERT L.R. GIBBS, MD - INCORPORATED
Entity Type:Organization
Organization Name:ROBERT L.R. GIBBS, MD - INCORPORATED
Other - Org Name:GIBBS MEDICAL ASSOCIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE ROOSEVELT
Authorized Official - Last Name:GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-611-2112
Mailing Address - Street 1:PO BOX 91554
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90009-1554
Mailing Address - Country:US
Mailing Address - Phone:877-611-2112
Mailing Address - Fax:877-469-2111
Practice Address - Street 1:15338 FLORWOOD AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2327
Practice Address - Country:US
Practice Address - Phone:877-611-2112
Practice Address - Fax:877-469-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73989207P00000X, 207R00000X, 208D00000X
CAA73898208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty