Organization Name: | BRIAN K GAMBLE, M.D. INC. |
NPI Number: | 1245300649 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BRIAN K GAMBLE (PRESIDENT) |
Mailing Address: | 3460 Wilshire Blvd Ste 1000 Los Angeles |
State: | CA US |
Postal Code: | 900102206 |
Phone Number: | 2134873845 |
Fax Number: | 2134876259 |
NPI Enumeration Date: | 11/09/2006 |
NPI Last Update Date: | 12/12/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A76121 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |