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NPI Code Detail

MEDICARE: GABRIELLE MARIE COLLINS FANNIN MD

MEDICARE: GABRIELLE MARIE COLLINS FANNIN 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
1171000000XMilitary Health Care ProviderDR.0076676CO

General Provider Information

NPI Number : 1467214767
Entity Type Code : Individual
Provider Name (Legal Business Name) : GABRIELLE MARIE COLLINS FANNIN MD
Provider Business Mailing Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : JBSA FT SAM HOUSTON
State : TX
Zip : 78234-4504
Country : US
Telephone Number : 210-916-8666
Fax Number :
Provider Business Practice Location Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : JBSA FT SAM HOUSTON
State : TX
Zip : 78234-4504
Country : US
Telephone Number : 210-916-8666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2024
Last Update Date : 01/29/2026

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