MEDICARE: PAMELA M GAMBLE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA02554	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	89N061	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1083604151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA M GAMBLE PA-C

Provider Business Mailing Address
First Line	:	2963 N SUNBECK CIR
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-7415
Country	:	US
Telephone Number	:	469-878-1321
Fax Number	:

Provider Business Practice Location Address
First Line	:	2963 N SUNBECK CIR
Second Line	:
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-7415
Country	:	US
Telephone Number	:	469-878-1321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	08/30/2012

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Directions to “ PAMELA M GAMBLE PA-C” Practice Location

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