Provider Demographics
NPI:1043213473
Name:GAMBRILL, RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:GAMBRILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 SW GRANDVIEW AVENUE
Mailing Address - Street 2:STE 200
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527
Mailing Address - Country:US
Mailing Address - Phone:541-479-8363
Mailing Address - Fax:541-476-2841
Practice Address - Street 1:1075 SW GRANDVIEW AVE
Practice Address - Street 2:STE 200
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527
Practice Address - Country:US
Practice Address - Phone:541-479-8363
Practice Address - Fax:541-476-2841
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08033207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218271Medicaid
OR218271Medicaid
OR108866Medicare ID - Type Unspecified