Healthcare Provider Details

I. General information

NPI: 1265499073
Provider Name (Legal Business Name): WILLIAM BRYAN GAMBLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11038 HAWKSHEAD CT
WINDERMERE FL
34786-5413
US

IV. Provider business mailing address

11038 HAWKSHEAD CT
WINDERMERE FL
34786-5413
US

V. Phone/Fax

Practice location:
  • Phone: 762-333-3196
  • Fax:
Mailing address:
  • Phone: 762-333-3196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number51108
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number51108
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: