Provider Demographics
NPI:1164695284
Name:GAMM, SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:GAMM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 SPRING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-8623
Mailing Address - Country:US
Mailing Address - Phone:417-334-5330
Mailing Address - Fax:417-339-2635
Practice Address - Street 1:136 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8623
Practice Address - Country:US
Practice Address - Phone:417-334-5330
Practice Address - Fax:417-339-2635
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002022729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1023027828OtherGROUP NPI
168923OtherBCBS
1023027828OtherGROUP NPI
168923OtherBCBS