Provider Demographics
NPI:1609074350
Name:GABLER, GLEN R (MD)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:R
Last Name:GABLER
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 1:29 W COLEYS CV
Mailing Address - Street 2:
Mailing Address - City:ELK RIDGE
Mailing Address - State:UT
Mailing Address - Zip Code:84651-4574
Mailing Address - Country:US
Mailing Address - Phone:801-423-3782
Mailing Address - Fax:
Practice Address - Street 1:29 W COLEYS CV
Practice Address - Street 2:
Practice Address - City:ELK RIDGE
Practice Address - State:UT
Practice Address - Zip Code:84651-4574
Practice Address - Country:US
Practice Address - Phone:801-423-3782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT313524-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine