=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427463835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2014
-----------------------------------------------------
Last Update Date | 06/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | #19 CARRETERA 132 MANSIONES DEL SUR
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00731
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-630-4101
-----------------------------------------------------
Fax | 787-840-8323
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 801207
-----------------------------------------------------
City | COTO LAUREL
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00780-1207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 939-630-4101
-----------------------------------------------------
Fax | 787-840-8323
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GABRIEL A MARTINEZ
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 939-630-4101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | 11939
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------