Provider Demographics
NPI:1033471768
Name:DE BOER, GABRIELA R (MD)
Entity type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:R
Last Name:DE BOER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:GABRIELA
Other - Middle Name:
Other - Last Name:RODRIGUEZ COLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3445
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-3445
Mailing Address - Country:US
Mailing Address - Phone:828-322-2050
Mailing Address - Fax:828-324-4271
Practice Address - Street 1:2424 CENTURY PL SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4031
Practice Address - Country:US
Practice Address - Phone:828-322-2050
Practice Address - Fax:828-345-0522
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23423207W00000X
NC2016-00916207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4188317OtherENVOLVE
NCA28835OtherEYEMED
NC4188317OtherAETNA
13837568OtherCAQH
NC1853558OtherWELLCARE
NC1033471768Medicaid
NC19LIPOtherBCBS