Basic Information
| Provider Information | |||||||||
| NPI: | 1972587095 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GABE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DANA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 347 FAIRVIEW ST | ||||||||
| Address2: | |||||||||
| City: | SILVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973811916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038735667 | ||||||||
| FaxNumber: | 5038735687 | ||||||||
| Practice Location | |||||||||
| Address1: | 347 FAIRVIEW ST | ||||||||
| Address2: | |||||||||
| City: | SILVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973811916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038735667 | ||||||||
| FaxNumber: | 5038735687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 10/27/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD15978 | OR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 068775 | 05 | OR | MEDICAID | M194501 | 01 | PACIFICSOURCE | OTHER | 688198002 | 01 | CIGNA | OTHER | 082667000 | 01 | BLUE CROSS | OTHER | 4649816 | 01 | AETNA | OTHER |