=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104089226
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURICE HELEN GABRIEL MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2008
-----------------------------------------------------
Last Update Date | 04/15/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2875 S OCEAN BLVD STE 208
-----------------------------------------------------
City | PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33480-5593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-588-0411
-----------------------------------------------------
Fax | 561-588-0919
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2875 S OCEAN BLVD STE 208
-----------------------------------------------------
City | PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33480-5593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-588-0411
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 4301092746
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------