Healthcare Provider Details

I. General information

NPI: 1427102086
Provider Name (Legal Business Name): JOHN WORTH GAMEL M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E MUHAMMAD ALI BLVD
LOUISVILLE KY
40202-1511
US

IV. Provider business mailing address

300 OREAD RD
LOUISVILLE KY
40207-1915
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5466
  • Fax:
Mailing address:
  • Phone: 502-290-5204
  • Fax: 502-290-5204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number19241
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: