Provider Demographics
NPI:1013508548
Name:GAMO, ABESELOM
Entity type:Individual
Prefix:
First Name:ABESELOM
Middle Name:
Last Name:GAMO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19988 E 40TH PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-7200
Mailing Address - Country:US
Mailing Address - Phone:720-579-6867
Mailing Address - Fax:
Practice Address - Street 1:19988 E 40TH PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-7200
Practice Address - Country:US
Practice Address - Phone:720-579-6867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver