Provider Demographics
NPI:1366494130
Name:GIBBS, MARK R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:GIBBS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9500 KANIS RD
Mailing Address - Street 2:STE 501
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-227-9080
Mailing Address - Fax:501-227-0410
Practice Address - Street 1:9500 KANIS RD
Practice Address - Street 2:STE 501
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-227-9080
Practice Address - Fax:501-227-0410
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-06-23
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Provider Licenses
StateLicense IDTaxonomies
ARC5967208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR112248001Medicaid
AR50327Medicare ID - Type Unspecified
B88945Medicare UPIN