Provider Demographics
NPI:1154308070
Name:GAMMON, ROBERT BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRUCE
Last Name:GAMMON
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 1:2821 GEORGE BUSH HWY STE 407
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4279
Mailing Address - Country:US
Mailing Address - Phone:972-680-0668
Mailing Address - Fax:972-680-2499
Practice Address - Street 1:4510 MEDICAL CENTER DR STE 312
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1604
Practice Address - Country:US
Practice Address - Phone:972-542-2186
Practice Address - Fax:972-542-1210
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8844207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044589201Medicaid
TXC75972Medicare UPIN