Basic Information
| Provider Information | |||||||||
| NPI: | 1316907736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GABRIEL | ||||||||
| FirstName: | JEROME | ||||||||
| MiddleName: | JAY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4722 N 24TH ST | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850164800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022564628 | ||||||||
| FaxNumber: | 6029579442 | ||||||||
| Practice Location | |||||||||
| Address1: | 9003 E SHEA BLVD | ||||||||
| Address2: | LABOR & DELIVERY, 2ND FL | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852606709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803231690 | ||||||||
| FaxNumber: | 4803233617 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2006 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 10716 | HI | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 29319 | AZ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 578693 | 05 | AZ | MEDICAID | H52075 | 01 | AZ | UPIN NUMBER | OTHER |