Individual
GLENN GREGORY GIBBONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
811 N B ST, FORT SMITH, AR 72901-2129
(479) 480-4850
(479) 480-4833
Mailing address
811 N B ST, FORT SMITH, AR 72901-2129
(479) 480-4850
(479) 480-4833
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E3378
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
148914001
—
AR
05
—
200004590A
—
OK
Enumeration date
10/06/2005
Last updated
06/11/2025
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