Gabriel Victor Goncalves Dierks Machado

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

1 College HL
Canton, MO 63435-1299

Phone

(573) 288-6000

NPI assigned

Jan 12, 2024

Last updated

Jan 12, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Gabriel Victor Goncalves Machado Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1705017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1821869298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N 4TH ST APT 1/2",
            "city": "CANTON",
            "state": "MO",
            "postal_code": "634351316",
            "telephone_number": "660-229-2466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 COLLEGE HL",
            "city": "CANTON",
            "state": "MO",
            "postal_code": "634351299",
            "telephone_number": "573-288-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONCALVES DIERKS MACHADO",
        "first_name": "GABRIEL VICTOR",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-12",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GABRIEL VICTOR",
            "last_name": "GONCALVES MACHADO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jessica Dwyer
• Dillon Farrell
• Daniel Kevin Fohey
• Blair Garmer, PHARMD
• Natalie Geralds
• Thomas Greene
• Xhane Greenidge
• Doniel James Greiner II
• Alexandra L Hambly-Clark
• Hannibal Regional Healthcare System, Inc (Canton/LaGrange Family Practice)

• Athletic Trainer in Canton, MO
• Providers in Canton, MO by specialty
• Athletic Trainer in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; 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.