Individual
MR. GABRIEL C FUQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3701 DOTY RD, WOODSTOCK, IL 60098
(815) 338-6600
(815) 206-5376
Mailing address
3701 DOTY RD, WOODSTOCK, IL 60098-7509
(815) 338-6600
(815) 206-5376
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
036142096
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036142096
STATE LICENSE
IL
Enumeration date
04/16/2013
Last updated
12/19/2018
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