Provider Demographics
NPI:1497258297
Name:GABLE, LACEY NOEL (DO)
Entity Type:Individual
Prefix:DR
First Name:LACEY
Middle Name:NOEL
Last Name:GABLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:NOEL
Other - Last Name:RUPPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:655 AFRICA RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9808
Mailing Address - Country:US
Mailing Address - Phone:614-865-3172
Mailing Address - Fax:614-865-2781
Practice Address - Street 1:655 AFRICA RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9808
Practice Address - Country:US
Practice Address - Phone:614-865-3172
Practice Address - Fax:614-865-2781
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-18
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.015896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program