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NPI Code Detail

MEDICARE: DR. SEAN JAMES GAMBLE M.D.

MEDICARE: DR. SEAN JAMES GAMBLE M.D.
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
1207LP3000XPediatric Anesthesiology Physician54612AZ
2208VP0000XPain Medicine Physician54612AZ

General Provider Information

NPI Number : 1417211921
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SEAN JAMES GAMBLE M.D.
Provider Business Mailing Address
First Line : 2108 E THOMAS RD STE 130
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-0008
Country : US
Telephone Number : 602-933-3124
Fax Number :
Provider Business Practice Location Address
First Line : 1919 E THOMAS RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85016-7710
Country : US
Telephone Number : 602-933-7246
Fax Number : 602-933-4341
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2012
Last Update Date : 05/28/2026

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