Provider Demographics
NPI:1376506824
Name:GABRIEL, JOSUE PERETRA (MD)
Entity Type:Individual
Prefix:
First Name:JOSUE
Middle Name:PERETRA
Last Name:GABRIEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3535 FISHINGER BLVD
Mailing Address - Street 2:STE 280
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7568
Mailing Address - Country:US
Mailing Address - Phone:614-222-0743
Mailing Address - Fax:614-222-0744
Practice Address - Street 1:3535 FISHINGER BLVD
Practice Address - Street 2:STE 280
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7568
Practice Address - Country:US
Practice Address - Phone:614-222-0743
Practice Address - Fax:614-222-0744
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036107556207XS0117X, 207X00000X
OH35.072606207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G95293Medicare UPIN