Healthcare Provider Details

I. General information

NPI: 1942324157
Provider Name (Legal Business Name): S. CAMPBELL GABRIELSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 N 1000 W
LINTON IN
47441-5281
US

IV. Provider business mailing address

1185 N 1000 W
LINTON IN
47441-5282
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-3381
  • Fax: 812-847-9496
Mailing address:
  • Phone: 812-847-3381
  • Fax: 812-847-9496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01039423A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: