Provider Demographics
NPI:1396747424
Name:GAMMENTHALER, SAMMY ARNOLD (MD)
Entity type:Individual
Prefix:DR
First Name:SAMMY
Middle Name:ARNOLD
Last Name:GAMMENTHALER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-1289
Mailing Address - Country:US
Mailing Address - Phone:352-343-1158
Mailing Address - Fax:352-343-8106
Practice Address - Street 1:1815 SALK AVE
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4311
Practice Address - Country:US
Practice Address - Phone:352-343-1158
Practice Address - Fax:352-343-8106
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38340207RC0000X
FLME108483207RC0000X
GA063196207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014122900Medicaid
NC89127F2Medicaid
GA908091490AMedicaid
FL14H8KOtherBCBS OF FL
NC127F2OtherBCBS NC INDIVIDUAL ID #
FL014122900Medicaid
GA202I061973Medicare PIN
GA908091490AMedicaid