Provider Demographics
NPI:1669025607
Name:GABBIN, ELLIOTT L
Entity Type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:L
Last Name:GABBIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9295 RIVERSIDE PKWY APT 16G
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-7341
Mailing Address - Country:US
Mailing Address - Phone:817-271-5111
Mailing Address - Fax:
Practice Address - Street 1:9295 RIVERSIDE PKWY APT 16G
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-7341
Practice Address - Country:US
Practice Address - Phone:817-271-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator