Provider Demographics
NPI:1629021498
Name:GAMBLE, BRADFORD A (MD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:A
Last Name:GAMBLE
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 1:6300 W PARKER RD
Mailing Address - Street 2:STE 326
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8100
Mailing Address - Country:US
Mailing Address - Phone:972-378-0633
Mailing Address - Fax:972-378-0656
Practice Address - Street 1:6300 W PARKER RD
Practice Address - Street 2:STE 326
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8100
Practice Address - Country:US
Practice Address - Phone:972-378-0633
Practice Address - Fax:972-378-0656
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83560XOtherBCBS PROVIDER NUMBER
040014024OtherMEDICARE RAILROAD PIN
TX7082003OtherAETNA PROVIDER NUMBER
TXG89108Medicare UPIN
TX83560XOtherBCBS PROVIDER NUMBER
TX82Z542Medicare PIN