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:
1144 SONOMA AVE
SUITE 101
SANTA ROSA, CA
ZIP 95405

Phone Number: (707) 775-0775



Detailed Information

DR. Larry Kyle Gambrell, D.O. is an otolaryngology/facial plastic surgeon otolaryngologist in Santa Rosa, CA with 13 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:

1144 SONOMA AVE
SUITE 101
SANTA ROSA, CA
ZIP 95405-812
Phone: (707) 775-0775

The enumeration date for this NPI number is 10/10/2006 and was last updated on 1/9/2013.

Map - Location of Practice

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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

NPI Record

No. Field Name Field Value
1 NPI 1275621963
2 Entity Type Code 1
3 Provider Last Name Legal Name GAMBRELL
4 Provider First Name LARRY
5 Provider Middle Name KYLE
6 Provider Name Prefix Text DR.
7 Provider Credential Text D.O.
8 Provider First Line Business Practice Location Address 1144 SONOMA AVE
9 Provider Second Line Business Practice Location Address SUITE 101
10 Provider Business Practice Location Address City Name SANTA ROSA
11 Provider Business Practice Location Address State Name CA
12 Provider Business Practice Location Address Postal Code 954054812
13 Provider Business Practice Location Address Country Code If outside U S US
14 Provider Business Practice Location Address Telephone Number 7077750775
15 Provider Enumeration Date 10/10/2006
16 Last Update Date 1/9/2013
17 Provider Gender Code M
18 Healthcare Provider Taxonomy Code 1 207YX0905X
19 Provider License Number 1 20A9837
20 Provider License Number State Code 1 CA
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Is Sole Proprietor Y

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.