Provider Demographics
NPI:1457324402
Name:GABRIEL, BONNIE L (MD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:GABRIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 CATTLEMEN RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6056
Mailing Address - Country:US
Mailing Address - Phone:941-379-5121
Mailing Address - Fax:941-379-4239
Practice Address - Street 1:3333 CATTLEMEN RD
Practice Address - Street 2:SUITE 208
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6056
Practice Address - Country:US
Practice Address - Phone:941-379-5121
Practice Address - Fax:941-379-4239
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74945207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254721000Medicaid
FL254721000Medicaid
FLE0349XMedicare PIN