Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036078399 | IL |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 036-078399 | IL |
NPI | 1346236304 |
---|---|
Provider Name | Keith R Gabriel |
First Address | Springfield, IL 62794-9639 |
Second Address | Springfield, IL 62769-1041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 31/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E80064 | (02) |