Healthcare Provider Details

I. General information

NPI: 1235525759
Provider Name (Legal Business Name): GABRIEL JOHNSON PLOURDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2015
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 MAIN ST
BAR HARBOR ME
04609
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD. L-579 OHSU
PORTLAND OR
97239
US

V. Phone/Fax

Practice location:
  • Phone: 207-288-5119
  • Fax: 207-801-5801
Mailing address:
  • Phone: 503-494-7592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD23210
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: