MEDICARE: LISA S GAMELL 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	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	ME99976	FL
2	207W00000X	Ophthalmology Physician	ME 99976	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11299	OTHER	FL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629051651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA S GAMELL MD

Provider Business Mailing Address
First Line	:	3242 COVE BEND DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-2752
Country	:	US
Telephone Number	:	813-265-6940
Fax Number	:	813-908-3937

Provider Business Practice Location Address
First Line	:	3242 COVE BEND DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-2752
Country	:	US
Telephone Number	:	813-265-6940
Fax Number	:	813-908-3937

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	10/15/2020

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Directions to “ LISA S GAMELL MD” Practice Location

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