Healthcare Provider Details

I. General information

NPI: 1518134154
Provider Name (Legal Business Name): BRYAN L GAMMON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 SAMARITAN DR
SAN JOSE CA
95124-3907
US

IV. Provider business mailing address

4131 DIRECTORS ROW
HOUSTON TX
77092-8703
US

V. Phone/Fax

Practice location:
  • Phone: 408-369-5600
  • Fax: 408-369-5625
Mailing address:
  • Phone: 877-697-2447
  • Fax: 855-697-2447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA118101
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberR0862
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: