Provider Demographics
NPI:1659482958
Name:GAMBRILL, STANLEY R (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:R
Last Name:GAMBRILL
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:1201 ALHAMBRA BLVD
Practice Address - Street 2:#300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5238
Practice Address - Country:US
Practice Address - Phone:916-451-4400
Practice Address - Fax:916-731-7957
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2015-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG40434207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G404340Medicaid
CA00G404341Medicare PIN
CA00G404340Medicaid
A92185Medicare UPIN