Provider Demographics
NPI:1750352373
Name:PEAL, GABRIEL MATONBA (MD)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:MATONBA
Last Name:PEAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S UNIVERSITY AVE STE 720
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5345
Mailing Address - Country:US
Mailing Address - Phone:501-558-4900
Mailing Address - Fax:501-558-4909
Practice Address - Street 1:500 S UNIVERSITY AVE STE 720
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5345
Practice Address - Country:US
Practice Address - Phone:501-558-4900
Practice Address - Fax:501-558-4909
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1660208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR485357OtherMEDICARE INDIVIDUAL PTAN
AR485340OtherMEDICARE
AR133831001Medicaid
AR1609260157OtherGROUP NPI
AR1609260157OtherGROUP NPI