Provider Demographics
NPI:1487759890
Name:GABR, MARK T (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:GABR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:180 RAMSGATE SQ. SE
Mailing Address - Street 2:SUITE# 150
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5867
Mailing Address - Country:US
Mailing Address - Phone:503-485-0672
Mailing Address - Fax:503-485-0673
Practice Address - Street 1:180 RAMSGATE SQ S
Practice Address - Street 2:SUITE# 150
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5864
Practice Address - Country:US
Practice Address - Phone:503-485-0672
Practice Address - Fax:503-485-0673
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD150992084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR127027Medicaid
OR127027Medicaid
ORC92674Medicare UPIN