Provider Demographics
NPI:1376032904
Name:CARRILLO, GABRIEL BRIAN (DO)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:BRIAN
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 432
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-0432
Mailing Address - Country:US
Mailing Address - Phone:606-218-3985
Mailing Address - Fax:
Practice Address - Street 1:26901 US HIGHWAY 119 N
Practice Address - Street 2:
Practice Address - City:BELFRY
Practice Address - State:KY
Practice Address - Zip Code:41514-7520
Practice Address - Country:US
Practice Address - Phone:606-237-0327
Practice Address - Fax:606-237-6624
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KY04797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program