Healthcare Provider Details

I. General information

NPI: 1386756021
Provider Name (Legal Business Name): THOMAS P GAMBINO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 36TH ST
VERO BEACH FL
32960-4862
US

IV. Provider business mailing address

PO BOX 19726
MIAMI FL
33101-9726
US

V. Phone/Fax

Practice location:
  • Phone: 772-567-4311
  • Fax: 904-346-0113
Mailing address:
  • Phone: 772-465-9770
  • Fax: 904-346-0113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberPA9101287
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: