Individual
DR. GLEN A GABRIELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1891 HONEYSUCKLE RD, STE C2, DOTHAN, AL 36305
(334) 794-6504
(334) 793-4452
Mailing address
1891 HONEYSUCKLE RD, STE C2, DOTHAN, AL 36305
(334) 794-6504
(334) 793-4452
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00012449
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000015369
—
AL
01
—
51523143
BLUE CROSS
AL
Enumeration date
05/09/2006
Last updated
05/15/2008
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