Provider Demographics
NPI:1730459009
Name:GAMBLE, ROBERT GLEN (DVM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GLEN
Last Name:GAMBLE
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 E MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4822
Mailing Address - Country:US
Mailing Address - Phone:307-857-1996
Mailing Address - Fax:307-857-5437
Practice Address - Street 1:1975 E MONROE AVE
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4822
Practice Address - Country:US
Practice Address - Phone:307-857-1996
Practice Address - Fax:307-857-5437
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1065174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian