Provider Demographics
NPI:1841238540
Name:GAMBLE, HUGH A II (MD)
Entity Type:Individual
Prefix:
First Name:HUGH
Middle Name:A
Last Name:GAMBLE
Suffix:II
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 1:344 ARNOLD AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-4711
Mailing Address - Country:US
Mailing Address - Phone:662-332-8131
Mailing Address - Fax:662-334-4478
Practice Address - Street 1:344 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4711
Practice Address - Country:US
Practice Address - Phone:662-332-8131
Practice Address - Fax:662-334-4478
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS067232086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00061867OtherRR MEDICARE
MS00019473Medicaid
AR107867001Medicaid
AR107867001Medicaid
MS330000034Medicare PIN