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NPI Code Detail

MEDICARE: DR. MICHAEL MILLER GAMBLE M.D.

MEDICARE: DR. MICHAEL MILLER GAMBLE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianC34623CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C34623OTHERCASTATE LICENSE
200C346230OTHERCAMEDICAL

General Provider Information

NPI Number : 1437116381
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL MILLER GAMBLE M.D.
Provider Business Mailing Address
First Line : 4568 SULLIVAN WAY
Second Line :
City : SANTA ROSA
State : CA
Zip : 95409-4220
Country : US
Telephone Number : 707-539-8121
Fax Number : 707-543-2032
Provider Business Practice Location Address
First Line : 1287 FULTON RD
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-4923
Country : US
Telephone Number : 707-543-2410
Fax Number : 707-543-2032
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 07/09/2007

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