Provider Demographics
NPI:1184625329
Name:GEBEL, MICHAEL ADAM (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ADAM
Last Name:GEBEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 41113
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-1113
Mailing Address - Country:US
Mailing Address - Phone:904-376-4400
Mailing Address - Fax:904-391-5595
Practice Address - Street 1:1340 S 18TH ST STE 104
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4733
Practice Address - Country:US
Practice Address - Phone:904-376-3707
Practice Address - Fax:904-391-5001
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2020-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01012435002084N0400X
FLME560942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE22885Medicare UPIN