Individual
GABRIEL MARTIN IBARRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
112 SOUTHLAKE CIR, CANTON, MS 39046-5368
(601) 859-8550
(601) 859-8556
Mailing address
112 SOUTHLAKE CIR, CANTON, MS 39046-5368
(601) 859-8550
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
MS
Other
Enumeration date
04/29/2019
Last updated
04/29/2019
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