Provider Demographics
NPI:1972587095
Name:GABE, MICHAEL DANA (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DANA
Last Name:GABE
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 1:347 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1916
Mailing Address - Country:US
Mailing Address - Phone:503-873-5667
Mailing Address - Fax:503-873-5687
Practice Address - Street 1:347 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1916
Practice Address - Country:US
Practice Address - Phone:503-873-5667
Practice Address - Fax:503-873-5687
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD15978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR068775Medicaid
M194501OtherPACIFICSOURCE
688198002OtherCIGNA
082667000OtherBLUE CROSS
4649816OtherAETNA
ORR0000BHZQHMedicare Oscar/Certification
082667000OtherBLUE CROSS
OR068775Medicaid