Healthcare Provider Details

I. General information

NPI: 1487656138
Provider Name (Legal Business Name): TERRY L GAMACHE D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1366 S 5TH ST
SAINT CHARLES MO
63301-2444
US

IV. Provider business mailing address

1366 S 5TH ST
SAINT CHARLES MO
63301-2444
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-9399
  • Fax: 636-947-1972
Mailing address:
  • Phone: 636-946-9399
  • Fax: 636-947-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000344
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: