Provider Demographics
NPI:1538157409
Name:DESCHAMPS, GABRIEL MARTIN (MD)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:MARTIN
Last Name:DESCHAMPS
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 1:6161 SUNSET DR
Mailing Address - Street 2:STE C
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5045
Mailing Address - Country:US
Mailing Address - Phone:305-447-4923
Mailing Address - Fax:
Practice Address - Street 1:6161 SUNSET DR
Practice Address - Street 2:STE C
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5045
Practice Address - Country:US
Practice Address - Phone:305-447-4923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76219207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G76290Medicare UPIN
FL44375XMedicare ID - Type UnspecifiedPROVIDER MEDICARE NUMBER
G76290Medicare UPIN