Provider Demographics
NPI:1770862641
Name:A MARK GAMBEE MD PA
Entity Type:Organization
Organization Name:A MARK GAMBEE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:A
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:GAMBEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-569-9500
Mailing Address - Street 1:2750 INDIAN RIVER BLVD
Mailing Address - Street 2:NULL
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5225
Mailing Address - Country:US
Mailing Address - Phone:772-569-9500
Mailing Address - Fax:772-569-9501
Practice Address - Street 1:2750 INDIAN RIVER BLVD
Practice Address - Street 2:NULL
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5225
Practice Address - Country:US
Practice Address - Phone:772-569-9500
Practice Address - Fax:772-569-9501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51946174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1821043829OtherTYPE 1 NPI