Provider Demographics
NPI:1063577765
Name:S A GABRIEL DO INC
Entity type:Organization
Organization Name:S A GABRIEL DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:H
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-278-8244
Mailing Address - Street 1:1501 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-4139
Mailing Address - Country:US
Mailing Address - Phone:937-278-8244
Mailing Address - Fax:937-274-8982
Practice Address - Street 1:8701 OLD TROY PIKE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-1066
Practice Address - Country:US
Practice Address - Phone:937-278-8244
Practice Address - Fax:937-274-8982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-25
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003827208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0701593Medicaid
OH1720129OtherUHC #
OH020044283OtherMEDICARE RAILROAD
OH284564686OtherTRICARE PROVIDER #
OH000000005821OtherBS & ANTHEM #
OH284564686001OtherMEDICAL MUTUAL PROVIDER #
OH28456468600OtherBWC PROVIDER #
OH1720129OtherUHC #
OH020044283OtherMEDICARE RAILROAD
OH000000005821OtherBS & ANTHEM #
OH=========026OtherCARE SOURCE
OH284564686001OtherMEDICAL MUTUAL PROVIDER #
OH9173467Medicare PIN
OH000000005821OtherBS & ANTHEM #
OH020044283OtherMEDICARE RAILROAD
OHA17434Medicare UPIN
OH9173461Medicare PIN
OH9173465Medicare PIN
OH9173466Medicare PIN