Provider Demographics
NPI:1568574267
Name:KHODR, GABRIEL S (MD)
Entity Type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:S
Last Name:KHODR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7614 LOUIS PASTEUR
Mailing Address - Street 2:#310 SOUTHWEST GENETICS PA
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-615-8237
Mailing Address - Fax:210-615-8239
Practice Address - Street 1:7614 LOUIS PASTEUR
Practice Address - Street 2:#310 SOUTHWEST GENETICS PA
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-615-8237
Practice Address - Fax:210-615-8239
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7140207SG0201X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B23930Medicare UPIN
00L24BMedicare ID - Type Unspecified