Provider Demographics
NPI:1790831865
Name:GAMBLE, MATTHEW D (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
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 1:2020 GRAVIER ST
Mailing Address - Street 2:7TH FLOOR SUITE B
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2272
Mailing Address - Country:US
Mailing Address - Phone:504-568-6004
Mailing Address - Fax:504-568-6006
Practice Address - Street 1:2020 GRAVIER ST
Practice Address - Street 2:7TH FLOOR SUITE B
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2272
Practice Address - Country:US
Practice Address - Phone:504-568-6004
Practice Address - Fax:504-568-6006
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2009772084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1075272Medicaid