Provider Demographics
NPI:1609824606
Name:GAMOKE, JAMES J (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:GAMOKE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S PARK ST
Mailing Address - Street 2:ST. MARYS HOSPITAL/DEAN MEDICAL CENTER
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1830
Mailing Address - Country:US
Mailing Address - Phone:608-258-5020
Mailing Address - Fax:608-258-5076
Practice Address - Street 1:700 S PARK ST
Practice Address - Street 2:ST. MARYS HOSPITAL/DEAN MEDICAL CENTER
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1830
Practice Address - Country:US
Practice Address - Phone:608-258-5020
Practice Address - Fax:608-258-5076
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52-023363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42903300Medicaid
WI744OtherDEAN HEALTH INSURANCE
WI744OtherDEAN HEALTH INSURANCE
R97858Medicare UPIN
WI42903300Medicaid