MEDICARE: DR. EDWARD MARTIN GABER M.D.

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	207R00000X	Internal Medicine Physician	011060	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4013190	OTHER	LA	AETNA PROV #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962406298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD MARTIN GABER M.D.

Provider Business Mailing Address
First Line	:	231 SAINT ANN DR
Second Line	:	STE 2
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3219
Country	:	US
Telephone Number	:	985-624-5410
Fax Number	:	985-624-5490

Provider Business Practice Location Address
First Line	:	231 SAINT ANN DR
Second Line	:	STE 2
City	:	MANDEVILLE
State	:	LA
Zip	:	70471-3219
Country	:	US
Telephone Number	:	985-624-5410
Fax Number	:	985-624-5490

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/06/2014

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