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General NPI Number Information
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NPI Number | 1083235444
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Entity Type | Individual
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Provider Name | CHRISTOPHER MICHAEL GAMBOA MD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 1787 ALLENDALE FAIRFAX HWY
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City | FAIRFAX
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State | SC
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Zip | 29827-9133
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Country | US
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Telephone | 803-632-3311
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Fax |
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Provider Business Mailing Address
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Address Line | 34 ONYX CT
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-0361
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Country | US
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Telephone | 904-887-9801
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 91160
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD29211
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MMD.91160
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | MD29211
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License Number State | ME
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