Provider Demographics
NPI:1609821545
Name:GABRIEL, ERIC MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MATTHEW
Last Name:GABRIEL
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 1:3 SHIRCLIFF WAY
Mailing Address - Street 2:SUITE 714
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4786
Mailing Address - Country:US
Mailing Address - Phone:904-308-2006
Mailing Address - Fax:904-308-7111
Practice Address - Street 1:3 SHIRCLIFF WAY
Practice Address - Street 2:SUITE 714
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4786
Practice Address - Country:US
Practice Address - Phone:904-308-2006
Practice Address - Fax:904-308-7111
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80322174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35367YMedicare ID - Type UnspecifiedMEDICARE