Provider Demographics
NPI:1558471763
Name:GABRIEL, BRETT ALLAN (DPM)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:ALLAN
Last Name:GABRIEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 BEACHVIEW ST
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1017213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018659501Medicaid
TX00DX95Medicare PIN
TX018659501Medicaid
TXT13352Medicare UPIN