Healthcare Provider Details

I. General information

NPI: 1639013667
Provider Name (Legal Business Name): PRECISION SURGICAL & WOUND CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2026
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 WOODLAND DR
PARK CITY UT
84098-5155
US

IV. Provider business mailing address

475 WOODLAND DR
PARK CITY UT
84098-5155
US

V. Phone/Fax

Practice location:
  • Phone: 414-534-8006
  • Fax:
Mailing address:
  • Phone: 414-534-8006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS CLARK GAMBLIN
Title or Position: MEDICAL DIRECTOR
Credential: MD, MS, MBA
Phone: 414-534-8006