Provider Demographics
NPI:1659550127
Name:GAMMEL, STEVEN DEWAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DEWAYNE
Last Name:GAMMEL
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 1:408 TYLER HOLMES DR
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MS
Mailing Address - Zip Code:38967-1522
Mailing Address - Country:US
Mailing Address - Phone:662-283-8205
Mailing Address - Fax:
Practice Address - Street 1:408 TYLER HOLMES DR
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MS
Practice Address - Zip Code:38967-1522
Practice Address - Country:US
Practice Address - Phone:662-283-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS20050OtherSTATE LICENSE