Provider Demographics
NPI:1427228121
Name:BRETT ALLAN GABRIEL
Entity Type:Organization
Organization Name:BRETT ALLAN GABRIEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:214-321-9410
Mailing Address - Street 1:1130 BEACHVIEW ST
Mailing Address - Street 2:STE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3705
Mailing Address - Country:US
Mailing Address - Phone:214-321-9410
Mailing Address - Fax:214-321-9437
Practice Address - Street 1:1130 BEACHVIEW ST
Practice Address - Street 2:STE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3705
Practice Address - Country:US
Practice Address - Phone:214-321-9410
Practice Address - Fax:214-321-9437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1017213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4251760001Medicare NSC
T13362Medicare UPIN
00DX95Medicare PIN