Provider Demographics
NPI:1386622827
Name:GABBIE, MARK O (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:O
Last Name:GABBIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2900 SAINT MICHAEL DR STE 401
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-5211
Mailing Address - Country:US
Mailing Address - Phone:903-614-5383
Mailing Address - Fax:903-614-5343
Practice Address - Street 1:3502 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0705
Practice Address - Country:US
Practice Address - Phone:903-614-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7084207Q00000X
TXH5885207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1G1604OtherMEDICARE
TX8M7710OtherBLUE CROSS BLUE SHIELD
AR113032001Medicaid
TXP02599443OtherRR MCR
OK100072350AMedicaid
TX127992908Medicaid
AR50271OtherBLUE CROSS BLUE SHIELD