Provider Demographics
NPI:1265493605
Name:GAMBLE, ALLEN E (DO)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:E
Last Name:GAMBLE
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 1:1900 S HIGHWAY 14 STE B
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4731
Mailing Address - Country:US
Mailing Address - Phone:864-469-3456
Mailing Address - Fax:864-282-8545
Practice Address - Street 1:1900 S HIGHWAY 14 STE B
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4731
Practice Address - Country:US
Practice Address - Phone:864-469-3456
Practice Address - Fax:864-282-8545
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC557207Q00000X
SCDO5572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC5577Medicaid
SC5577Medicaid
SCG84085Medicare UPIN