Provider Demographics
NPI:1417109133
Name:GAMBRILL, CAROL DEANN (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:DEANN
Last Name:GAMBRILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 CORPORATE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-5113
Mailing Address - Country:US
Mailing Address - Phone:713-773-0803
Mailing Address - Fax:713-271-5422
Practice Address - Street 1:7001 CORPORATE DR
Practice Address - Street 2:STE 120
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-5113
Practice Address - Country:US
Practice Address - Phone:713-773-0803
Practice Address - Fax:713-275-0951
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS6841207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200212230AMedicaid
OK321185YK1NMedicare PIN