MEDICARE: JOHN D GABRIEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	F1559	TX

General Provider Information

NPI Number	:	1407844764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN D GABRIEL MD

Provider Business Mailing Address
First Line	:	4351 BOOTH CALLOWAY RD
Second Line	:	#101
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-7378
Country	:	US
Telephone Number	:	817-284-1165
Fax Number	:	817-284-2677

Provider Business Practice Location Address
First Line	:	4351 BOOTH CALLOWAY RD
Second Line	:	#101
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-7378
Country	:	US
Telephone Number	:	817-284-1165
Fax Number	:	817-284-2677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	08/15/2013

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