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General NPI Number Information
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NPI Number | 1861695314
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Entity Type | Organization
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Legal Business Name | BRIAN K GAMBLE, M.D. INC.
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18701 SHERMAN WAY STE 2
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City | RESEDA
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State | CA
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Zip | 91335-4045
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Country | US
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Telephone | 818-786-5360
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Fax | 818-786-5370
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Provider Business Mailing Address
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Address Line | 18701 SHERMAN WAY STE 2
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City | RESEDA
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State | CA
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Zip | 91355-4049
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Country | US
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Telephone | 818-786-5360
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Fax | 818-786-5370
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Authorized Official
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Title or Position | C.E.O.
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Name | DR. BRIAN KEITH GAMBLE
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Credential | M.D.
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Telephone | 818-786-5360
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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 | A76121
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License Number State | CA
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