Provider Demographics
NPI:1316907736
Name:GABRIEL, JEROME JAY (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:JAY
Last Name:GABRIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4722 N 24TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4800
Mailing Address - Country:US
Mailing Address - Phone:602-256-4628
Mailing Address - Fax:602-957-9442
Practice Address - Street 1:9003 E SHEA BLVD
Practice Address - Street 2:LABOR & DELIVERY, 2ND FL
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6709
Practice Address - Country:US
Practice Address - Phone:480-323-1690
Practice Address - Fax:480-323-3617
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10716207V00000X
AZ29319207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ578693Medicaid
AZH52075OtherUPIN NUMBER
AZH52075OtherUPIN NUMBER