NPIMap

Organization Active NPI

Glen Gabrielson

  • Family Medicine Physician
  • Dothan, AL
National Provider Identifier
1427210491
Registry record updated Sep 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
12449 Issued in AL
Legal business name
GLEN GABRIELSON
Practice address
1891 Honeysuckle Rd
Ste 2
Dothan, AL 36305-4290
Phone
(334) 794-6504
Fax
(334) 793-4452
NPI assigned
Jun 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Glen A Gabrielson, MD
Title
Physician/Owner
Phone
(334) 794-6504

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 12449 AL Primary

Addresses

Primary practice location

1891 Honeysuckle Rd
Ste 2
Dothan, AL 36305-4290

Mailing address

1891 Honeysuckle Rd
Ste 2
Dothan, AL 36305-4290
Phone (334) 794-6504

Other identifiers 1

IdentifierTypeStateIssuer
1427210491MedicaidAL

Other names 1

  • Dothan Family Practice Doing business as

National Provider Directory

National Provider Directory

Locations

1891 Honeysuckle Rd
Ste C2
Dothan, AL 36305
Phone (334) 794-6504

1891 Honeysuckle Rd
Ste 2
Dothan, AL 36305
Phone (334) 794-6504

1805 W Main St
Ste 1
Dothan, AL 36301

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221782400000",
    "number": "1427210491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1891 HONEYSUCKLE RD",
            "address_2": "STE 2",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363054290",
            "telephone_number": "334-794-6504",
            "fax_number": "334-793-4452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1891 HONEYSUCKLE RD",
            "address_2": "STE 2",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363054290",
            "telephone_number": "334-794-6504",
            "fax_number": "334-793-4452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN GABRIELSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-30",
        "last_updated": "2008-09-19",
        "status": "A",
        "authorized_official_last_name": "GABRIELSON",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "334-794-6504",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "12449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1427210491",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dothan Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.