Provider Demographics
NPI:1033264072
Name:LOMBARD, GABRIEL P (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:P
Last Name:LOMBARD
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 1:148 CHALAN TASI
Mailing Address - Street 2:PAGO BAY
Mailing Address - City:CHALAN PAGO
Mailing Address - State:GU
Mailing Address - Zip Code:96910-0000
Mailing Address - Country:US
Mailing Address - Phone:671-789-4638
Mailing Address - Fax:671-646-3639
Practice Address - Street 1:851 GOVERNOR CARLOS CAMACHO ROAD
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3153
Practice Address - Country:US
Practice Address - Phone:671-300-0840
Practice Address - Fax:671-647-0832
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM464208D00000X
AZ17232208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GU611Medicaid
GUM464OtherGUAM BOARD OF MEDICAL EXAMINERS LICENSURE
GUM464OtherGUAM BOARD OF MEDICAL EXAMINERS LICENSURE
0000BDXJTMedicare UPIN
HI611Medicaid