Provider Demographics
NPI:1083604151
Name:GAMBLE, PAMELA M (PA-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2963 N SUNBECK CIR
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7415
Mailing Address - Country:US
Mailing Address - Phone:469-878-1321
Mailing Address - Fax:
Practice Address - Street 1:2963 N SUNBECK CIR
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-7415
Practice Address - Country:US
Practice Address - Phone:469-878-1321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02554363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89N061OtherBCBS
TX89N061OtherBCBS
83N467Medicare PIN