Provider Demographics
NPI:1700075389
Name:GABLER, MATTHEW G (PA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:G
Last Name:GABLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 GAUSE BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2937
Mailing Address - Country:US
Mailing Address - Phone:985-649-2700
Mailing Address - Fax:
Practice Address - Street 1:901 GAUSE BLVD FL 2
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2937
Practice Address - Country:US
Practice Address - Phone:985-649-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200136363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1020346Medicaid
LA57061P907Medicare PIN