Provider Demographics
NPI:1639119217
Name:GABRIELSON, DANIEL MACK (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:MACK
Last Name:GABRIELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 S MAIN ST. PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1316 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-2019
Practice Address - Country:US
Practice Address - Phone:515-532-3406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3611207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0424507Medicaid
IA0283465Medicaid
IA0293522Medicaid
IA0600460Medicaid
IA33444OtherFPC BCBS NRH
IA66046OtherBCBS SNF
IA0655001Medicaid
IA0635011Medicaid
IA29352OtherBCBS ER
IA60046OtherBCBS REG
IA36174OtherBCBS DME
IA0293522Medicaid
IACE8231Medicare Oscar/Certification
IA0381980001Medicare NSC
IA0635011Medicaid
IA0600460Medicaid
IA0283465Medicaid
IA33444OtherFPC BCBS NRH
IAI28108Medicare UPIN