Provider Demographics
NPI:1578821963
Name:EDWARDS, GABRIEL P (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:P
Last Name:EDWARDS
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 1:1648 ELLIS ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8811
Mailing Address - Country:US
Mailing Address - Phone:406-587-8631
Mailing Address - Fax:406-587-1343
Practice Address - Street 1:1648 ELLIS ST STE 201
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8811
Practice Address - Country:US
Practice Address - Phone:406-587-8631
Practice Address - Fax:406-587-1343
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY13480A2085R0204X
MTMED-PHYS-LIC-1298222085R0202X, 2085R0204X
CODR.00658272085R0204X
NE333592085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology