DR. LARRY KYLE GAMBRELL, D.O. - NPI NUMBER 1275621963

Summary

Provider Name: DR. LARRY KYLE GAMBRELL, D.O.

NPI Number: 1275621963

Clasification: Otolaryngology (207YX0905X)

Specialization: Otolaryngology/Facial Plastic Surgery

Organization: ENTEGRATIVE OTOLARYNGOLOGY PC

Address:
6880 PALM AVENUE
SEBASTOPOL, CA
ZIP 95472

Phone Number: (707) 823-7628



Detailed Information

DR. Larry Kyle Gambrell, D.O. is an otolaryngology/facial plastic surgeon otolaryngologist in Sebastopol, CA with 14 years of experience. The provider is an otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions. The assigned NPI number for this provider is 1275621963 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: OKLAHOMA COLLEGE OF OSTEOPATHIC MEDICINE AND SURGERY
Graduation Year: 2001

The provider's business address is:

6880 PALM AVENUE
SEBASTOPOL, CA
ZIP 95472
Phone: (707) 823-7628
Fax: (707) 823-1521

The enumeration date for this NPI number is 10/10/2006 and was last updated on 3/3/2015.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1750616512 NORTH COAST FACULTY MEDICAL GROUP INC
Otolaryngology





Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery 20A9837 CA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 CA107813 OTHER CA MEDICARE

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1275621963 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name GAMBRELL The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name LARRY The first name of the provider, if the provider is an individual.
5 Provider Middle Name KYLE The middle name of the provider, if the provider is an individual.
6 Provider Name Prefix Text DR. The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
7 Provider Credential Text D.O. The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
8 Provider First Line Business Practice Location Address 6880 PALM AVENUE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name SEBASTOPOL The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name CA The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 95472 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 7078237628 The telephone number associated with the location address of the provider being identified.
14 Provider Business Practice Location Address Fax Number 7078231521 The fax number associated with the location address of the provider being identified.
15 Provider Enumeration Date 10/10/2006 The date the provider was assigned a unique identifier (assigned an NPI).
16 Last Update Date 3/3/2015 The date that a record was last updated or changed.
17 Provider Gender Code M The code designating the provider’s gender if the provider is a person.
18 Healthcare Provider Taxonomy Code 1 207YX0905X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Provider License Number 1 20A9837 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
20 Provider License Number State Code 1 CA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 CA107813 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
23 Other Provider Identifier Type Code 1 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier State 1 CA
25 Other Provider Identifier Issuer 1 MEDICARE
26 Is Sole Proprietor Y Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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