Provider Demographics
NPI:1376662148
Name:COUSENS, GABRIEL K (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:K
Last Name:COUSENS
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:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:PATAGONIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85624-0778
Mailing Address - Country:US
Mailing Address - Phone:520-394-2520
Mailing Address - Fax:415-528-2409
Practice Address - Street 1:686 HARSHAW AVE.
Practice Address - Street 2:
Practice Address - City:PATAGONIA
Practice Address - State:AZ
Practice Address - Zip Code:85624
Practice Address - Country:US
Practice Address - Phone:520-394-2520
Practice Address - Fax:415-598-2409
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ030175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath