Provider Demographics
NPI:1295995439
Name:GAMBLE, MARYANN C (MD)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:C
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 US 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:3420 FM 967 STE B100
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-3113
Practice Address - Country:US
Practice Address - Phone:512-295-1333
Practice Address - Fax:512-295-1335
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201845903Medicaid
TX201845902Medicaid
TXP01050719Medicare PIN
TXTXB139023Medicare PIN
TXTXB139025Medicare PIN