Healthcare Provider Details

I. General information

NPI: 1376032904
Provider Name (Legal Business Name): GABRIEL BRIAN CARRILLO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26901 US HIGHWAY 119 N
BELFRY KY
41514-7520
US

IV. Provider business mailing address

PO BOX 432
PIKEVILLE KY
41502-0432
US

V. Phone/Fax

Practice location:
  • Phone: 606-237-0327
  • Fax: 606-237-6624
Mailing address:
  • Phone: 606-218-3985
  • Fax:

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 Number04797
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: