Provider Demographics
NPI:1184637282
Name:GABRIEL, LARRY CHARLES (MD)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:CHARLES
Last Name:GABRIEL
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1034 MAR WALT DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6639
Mailing Address - Country:US
Mailing Address - Phone:850-862-4001
Mailing Address - Fax:850-862-1612
Practice Address - Street 1:1034 MAR WALT DR
Practice Address - Street 2:STE 200
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6639
Practice Address - Country:US
Practice Address - Phone:850-862-4001
Practice Address - Fax:850-862-1612
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME111546207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA9667180001Medicaid
PA9667180001Medicaid
069822Medicare ID - Type Unspecified