Provider Demographics
NPI:1508800244
Name:GAMBON, THRESIA B (MD)
Entity Type:Individual
Prefix:
First Name:THRESIA
Middle Name:B
Last Name:GAMBON
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:551 WEST 51ST PLACE
Mailing Address - Street 2:CITRUS HEALTH NETWORK INC
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3300
Mailing Address - Country:US
Mailing Address - Phone:305-817-6560
Mailing Address - Fax:786-209-2030
Practice Address - Street 1:551 WEST 51ST PLACE
Practice Address - Street 2:CITRUS HEALTH NETWORK INC
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3300
Practice Address - Country:US
Practice Address - Phone:305-817-6560
Practice Address - Fax:786-209-2030
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-12-12
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Provider Licenses
StateLicense IDTaxonomies
FLME0072798208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG61305Medicare UPIN