Provider Demographics
NPI:1629506779
Name:GABRIEL, ANDRE (MD)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:GABRIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 CENTURY MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-2113
Mailing Address - Country:US
Mailing Address - Phone:321-633-8660
Mailing Address - Fax:321-268-6164
Practice Address - Street 1:5005 PORT ST JOHN PKWY
Practice Address - Street 2:
Practice Address - City:PORT ST JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-4305
Practice Address - Country:US
Practice Address - Phone:321-633-8660
Practice Address - Fax:321-268-6164
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2024-11-27
Deactivation Date:2018-02-07
Deactivation Code:
Reactivation Date:2018-05-22
Provider Licenses
StateLicense IDTaxonomies
FLME165688207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease