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General NPI Number Information
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NPI Number | 1346236304
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Entity Type | Individual
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Provider Name | KEITH R GABRIEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 07/31/2013
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Provider Practice Location Address
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Address Line | 800 E CARPENTER ST
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City | SPRINGFIELD
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State | IL
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Zip | 62769-1041
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Country | US
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Telephone | 217-757-6535
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Fax | 217-757-6536
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Provider Business Mailing Address
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Address Line | PO BOX 19639
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City | SPRINGFIELD
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State | IL
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Zip | 62794-9639
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Country | US
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Telephone | 217-545-7578
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Fax | 217-545-1884
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 036078399
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number | 036-078399
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License Number State | IL
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