Provider Demographics
NPI:1982699591
Name:GAMBLA, KURT MICHAEL (DO)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:MICHAEL
Last Name:GAMBLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:955 RIBAUT RD
Mailing Address - Street 2:BMAC CREDENTIALING
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5441
Mailing Address - Country:US
Mailing Address - Phone:843-522-7843
Mailing Address - Fax:843-522-5678
Practice Address - Street 1:989 RIBAUT RD
Practice Address - Street 2:SUITE 260
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5472
Practice Address - Country:US
Practice Address - Phone:843-522-7600
Practice Address - Fax:843-522-7612
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2019-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC000267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC002678Medicaid
SC002678Medicaid
SC002678Medicaid
SCE687356305Medicare PIN