Provider Demographics
NPI:1568484418
Name:NAZARENO, GABRIEL U (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:U
Last Name:NAZARENO
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 70365
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107-0365
Mailing Address - Country:US
Mailing Address - Phone:334-263-2301
Mailing Address - Fax:334-263-0881
Practice Address - Street 1:3060 MOBILE HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36108-4027
Practice Address - Country:US
Practice Address - Phone:334-293-6670
Practice Address - Fax:334-293-6676
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00023197207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51515518OtherBCBS
AL630813275OtherCOMMERICIAL PRV
AL630813275OtherCOMMERICIAL GRP
AL630904063Medicaid
ALP00426546OtherRAILROAD MEDICARE
AL51515517OtherBCBS
AL630813275OtherWORKMAN COMP
AL51505044OtherBCBS
AL0403254OtherUNITED HEALTHCARE
AL630901063Medicaid
AL051540268OtherBLUE CROSS BLUE SHIELD
AL051540268Medicaid
AL630900063Medicaid
AL630910063Medicaid
AL630902063Medicaid
AL51505044OtherBCBS
AL051540268Medicaid
AL630902063Medicaid