Provider Demographics
NPI:1528727245
Name:PELAYO, GABRIEL J
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:J
Last Name:PELAYO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5535 NW CACHE RD APT 9A
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-3341
Mailing Address - Country:US
Mailing Address - Phone:918-381-9432
Mailing Address - Fax:
Practice Address - Street 1:5535 NW CACHE RD APT 9A
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-3341
Practice Address - Country:US
Practice Address - Phone:918-381-9432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA