Provider Demographics
NPI:1720209257
Name:GABBERT, ELMO P
Entity Type:Individual
Prefix:DR
First Name:ELMO
Middle Name:P
Last Name:GABBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ELMO
Other - Middle Name:P
Other - Last Name:GABBERT
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39653
Mailing Address - Country:US
Mailing Address - Phone:601-384-5801
Mailing Address - Fax:601-384-4100
Practice Address - Street 1:40 UNION CHURCH RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:MS
Practice Address - Zip Code:39653
Practice Address - Country:US
Practice Address - Phone:601-384-5801
Practice Address - Fax:601-384-4100
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04510282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0011530Medicaid
MSB66044Medicare UPIN
MS081261498Medicare PIN