Provider Demographics
NPI:1023045556
Name:OJEDA, GABRIEL A (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:A
Last Name:OJEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 DOHI DR
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-2851
Mailing Address - Country:US
Mailing Address - Phone:865-647-3520
Mailing Address - Fax:865-647-3529
Practice Address - Street 1:202 DOHI DR
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774-2851
Practice Address - Country:US
Practice Address - Phone:865-647-3520
Practice Address - Fax:865-647-3529
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21117207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3072909Medicaid
TN060040858OtherRR MEDICARE PIN
TN3706633OtherMEDICARE GROUP
TN3706633OtherMEDICARE GROUP
TN3072909Medicaid