Provider Demographics
NPI:1598713364
Name:MERRILL, GABRIEL (PAC)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:
Last Name:MERRILL
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-849 LUMIAINA ST UNIT 202
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-5677
Mailing Address - Country:US
Mailing Address - Phone:808-437-2881
Mailing Address - Fax:
Practice Address - Street 1:94-849 LUMIAINA ST UNIT 202
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5677
Practice Address - Country:US
Practice Address - Phone:808-437-2881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAMD239363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI5744241OtherUHA
HI0000251389OtherHMSA
HI576697Medicaid
Q50041Medicare UPIN
HI5744241OtherUHA