Provider Demographics
NPI:1982233599
Name:AMON, GABRIEL JEROME (MD)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:JEROME
Last Name:AMON
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 1:119 14TH ST NW STE 240
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-0007
Mailing Address - Country:US
Mailing Address - Phone:763-571-4000
Mailing Address - Fax:
Practice Address - Street 1:18315 CASCADE DR STE 150
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-1185
Practice Address - Country:US
Practice Address - Phone:952-934-7336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN77244207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology