Provider Demographics
NPI:1073528840
Name:GABBERT, MICHAEL K (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:GABBERT
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 1:1700 CURIE DR STE 5600
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2986
Mailing Address - Country:US
Mailing Address - Phone:915-532-4413
Mailing Address - Fax:915-532-3739
Practice Address - Street 1:1700 CURIE DR STE 5600
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2986
Practice Address - Country:US
Practice Address - Phone:915-532-4413
Practice Address - Fax:915-532-3739
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0924207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00NJ64OtherBC BS PROVIDER NUMBER
TX00NJ64OtherTEXAS MEDICARE PROVIDER NUMBER
TX0351801-01Medicaid
P00067638OtherRAILROD MEDICARE PROV #
P00067638OtherRAILROD MEDICARE PROV #