Provider Demographics
NPI:1598800062
Name:GAMMON, JAMES ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALLEN
Last Name:GAMMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J.
Other - Middle Name:ALLEN
Other - Last Name:GAMMON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:500 COFFEE ROAD
Mailing Address - Street 2:SUITE F
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355
Mailing Address - Country:US
Mailing Address - Phone:209-522-8004
Mailing Address - Fax:209-522-7314
Practice Address - Street 1:500 COFFEE ROAD
Practice Address - Street 2:SUITE F
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-522-7362
Practice Address - Fax:209-522-7314
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC334380207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A35277Medicare UPIN
00C334380Medicare ID - Type Unspecified