Provider Demographics
NPI:1205021912
Name:ONOFRE, GABRIEL ESTEBAN (MD)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ESTEBAN
Last Name:ONOFRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 DECATUR ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1848
Mailing Address - Country:US
Mailing Address - Phone:678-843-8600
Mailing Address - Fax:734-732-4143
Practice Address - Street 1:424 DECATUR ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1848
Practice Address - Country:US
Practice Address - Phone:678-843-8600
Practice Address - Fax:734-732-4143
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA195819055FMedicaid