Healthcare Provider Details

I. General information

NPI: 1659830636
Provider Name (Legal Business Name): NICOLAS JOSEPH SANCHEZ GAMBLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 N OGDEN ST STE 460
DENVER CO
80218-3670
US

IV. Provider business mailing address

1960 N OGDEN ST STE 460
DENVER CO
80218-3670
US

V. Phone/Fax

Practice location:
  • Phone: 303-318-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL000
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0067267
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: