Provider Demographics
NPI:1336219153
Name:CABALO, GERRY II (MD)
Entity type:Individual
Prefix:MR
First Name:GERRY
Middle Name:
Last Name:CABALO
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GERARDO
Other - Middle Name:CABABAT
Other - Last Name:CABALO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3170
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607
Mailing Address - Country:US
Mailing Address - Phone:828-262-1800
Mailing Address - Fax:828-262-5444
Practice Address - Street 1:245 WINKLERS CREEK ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7838
Practice Address - Country:US
Practice Address - Phone:828-262-1800
Practice Address - Fax:828-262-5444
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904008Medicaid
NC5904008Medicaid
NC2060705Medicare ID - Type Unspecified