MEDICARE: DR. GABRIELA R DE BOER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	2016-00916	NC
2	207W00000X	Ophthalmology Physician	23423	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19LIP	OTHER	NC	BCBS
2	4188317	OTHER	NC	ENVOLVE
3	4188317	OTHER	NC	AETNA
4	A28835	OTHER	NC	EYEMED
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	13837568	OTHER		CAQH
7	1853558	OTHER	NC	WELLCARE

General Provider Information

NPI Number	:	1033471768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIELA R DE BOER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3445
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28603-3445
Country	:	US
Telephone Number	:	828-322-2050
Fax Number	:	828-324-4271

Provider Business Practice Location Address
First Line	:	PR 1 AVE SAKURA
Second Line	:	PLAZA BAIROA SUITE 245
City	:	CAGUAS
State	:	PR
Zip	:	00725
Country	:	US
Telephone Number	:	787-641-3030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2012
Last Update Date	:	12/31/2025

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Directions to “ DR. GABRIELA R DE BOER M.D.” Practice Location

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