Individual provider Active NPI

Gustavo Adolfo Fabrega, M.D.

  • Anesthesiology Physician
  • Lawton, OK
National Provider Identifier
1649467390
Registry record updated Sep 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
28388 Issued in OK
Practice address
3401 W Gore Blvd
Lawton, OK 73505-6332
Phone
(580) 355-8620
NPI assigned
Sep 26, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 28388 OK Primary

Addresses

Primary practice location

3401 W Gore Blvd
Lawton, OK 73505-6332

Mailing address

3709 NE Eastlake Dr
Lawton, OK 73507-4205
Phone (225) 936-2229

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120104000734 OK Practitioner - Anesthesiology 5092981563 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Tulane University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergenchealth PLLCGroup PAC ID 1355606641, 1,037 clinicians

Practice addresses (Care Compare)

10512 N 110TH E Ave
Bailey Med Ctr
Owasso, OK 74055-6636
Phone (918) 376-8000

Hospital & facility affiliations

  • Memorial Health Hospital, Lawton, OK, CCN 370056

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
28388OKMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergenchealth PLLC Anesthesiology CurrentSince Oct 19, 2020 Accepting new patients

Locations

3401 W Gore Blvd
Lawton, OK 73505
Phone (580) 483-5207

10512 N 110th East Ave
Owasso, OK 74055
Phone (918) 272-1172

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315785600000",
    "number": "1649467390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3709 NE EASTLAKE DR",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735074205",
            "telephone_number": "225-936-2229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 W GORE BLVD",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "735056332",
            "telephone_number": "580-355-8620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FABREGA",
        "first_name": "GUSTAVO",
        "middle_name": "ADOLFO",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-26",
        "last_updated": "2011-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OK",
            "license": "28388",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

Verify at the official NPI Registry.