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1275573107

NPI Code Detail

MEDICARE: DR. CHARLES E GAMBLA MD

MEDICARE: DR. CHARLES E GAMBLA MD

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	207N00000X	Dermatology Physician	00023999	AL
2	207ND0101X	MOHS-Micrographic Surgery Physician	00023999	AL
3	207NS0135X	Procedural Dermatology Physician	00023999	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051504238	OTHER	AL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275573107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES E GAMBLA MD

Provider Business Mailing Address
First Line	:	4410 WATERMELON RD
Second Line	:
City	:	NORTHPORT
State	:	AL
Zip	:	35473-5204
Country	:	US
Telephone Number	:	205-345-1520
Fax Number	:	205-345-1761

Provider Business Practice Location Address
First Line	:	4410 WATERMELON RD
Second Line	:
City	:	NORTHPORT
State	:	AL
Zip	:	35473-5204
Country	:	US
Telephone Number	:	205-345-1520
Fax Number	:	205-345-1761

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	09/28/2010

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Directions to “ DR. CHARLES E GAMBLA MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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