Provider Demographics
NPI:1396724613
Name:GAMBLE, JASON PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:PAUL
Last Name:GAMBLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0777
Mailing Address - Country:US
Mailing Address - Phone:205-481-7670
Mailing Address - Fax:205-481-7573
Practice Address - Street 1:927 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-6081
Practice Address - Country:US
Practice Address - Phone:205-481-8670
Practice Address - Fax:205-424-4927
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL22042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051004982OtherBLUE CROSS
AL009941206Medicaid
H18389Medicare UPIN
AL051558147Medicare UPIN