Provider Demographics
NPI:1376983130
Name:MARTINEZ GAMBA, GERMAN NICOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:GERMAN
Middle Name:NICOLAS
Last Name:MARTINEZ GAMBA
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 1:104 E. US HIGHWAY 60
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:MO
Mailing Address - Zip Code:65548
Mailing Address - Country:US
Mailing Address - Phone:417-934-2251
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 170
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3003
Practice Address - Country:US
Practice Address - Phone:832-325-6500
Practice Address - Fax:713-512-2203
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO431560263OtherTRICARE
MOP01222568OtherRR MCR
MO1376983130Medicaid
MO431560263OtherTRICARE