Provider Demographics
NPI:1184080210
Name:GUERRERO, GABRIEL (DO)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:GUERRERO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:372 S EAGLE RD # 126
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-5908
Mailing Address - Country:US
Mailing Address - Phone:208-391-7210
Mailing Address - Fax:208-391-2130
Practice Address - Street 1:74 N FISHER PARK WAY
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4704
Practice Address - Country:US
Practice Address - Phone:208-391-7210
Practice Address - Fax:208-391-2130
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-1094207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery