Healthcare Provider Details

I. General information

NPI: 1427542828
Provider Name (Legal Business Name): GABRIELLE FLAMM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 11/15/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 KANAKANAK ROAD
DILLINGHAM AK
99576
US

IV. Provider business mailing address

2323 KNOLL DR STE 219
VENTURA CA
93003-7307
US

V. Phone/Fax

Practice location:
  • Phone: 907-842-5201
  • Fax:
Mailing address:
  • Phone: 805-677-5181
  • Fax: 805-677-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number180550
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: