=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427228121
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRETT ALLAN GABRIEL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2008
-----------------------------------------------------
Last Update Date | 03/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1130 BEACHVIEW ST STE 200
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75218-3705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-321-9410
-----------------------------------------------------
Fax | 214-321-9437
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1130 BEACHVIEW ST STE 200
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75218-3705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-321-9410
-----------------------------------------------------
Fax | 214-321-9437
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRETT GABRIEL
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 214-321-9410
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 1017
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------