Provider Demographics
NPI:1750334702
Name:URIBE, LUIS GABRIEL (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:GABRIEL
Last Name:URIBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:200 W ESPLANADE
Mailing Address - Street 2:#103
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065
Mailing Address - Country:US
Mailing Address - Phone:504-464-8712
Mailing Address - Fax:504-464-8711
Practice Address - Street 1:200 W ESPLANADE
Practice Address - Street 2:#103
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065
Practice Address - Country:US
Practice Address - Phone:504-464-8712
Practice Address - Fax:504-464-8711
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA07422R207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1368644Medicaid
LA1368644Medicaid
LA53316Medicare PIN