Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD08033 | OR |
NPI | 1043213473 |
---|---|
Provider Name | Dr. Raymond Gambrill |
First Address | Grants Pass, OR 97527 |
Second Address | Grants Pass, OR 97527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 19/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
218271 | (05) | OR |
C92683 | (02) | OR |