Healthcare Provider Details

I. General information

NPI: 1538307236
Provider Name (Legal Business Name): KELLY BRUCE GABEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E COLLEGE DR
COLBY KS
67701-3716
US

IV. Provider business mailing address

310 E COLLEGE DR
COLBY KS
67701-3716
US

V. Phone/Fax

Practice location:
  • Phone: 785-462-6184
  • Fax: 785-460-1490
Mailing address:
  • Phone: 785-462-6184
  • Fax: 785-460-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5101017851
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number116929
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: