Provider Demographics
NPI:1831177500
Name:GAMBINO, DEAN R (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:R
Last Name:GAMBINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:726 N GREENFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5061
Mailing Address - Country:US
Mailing Address - Phone:480-833-8620
Mailing Address - Fax:480-969-3952
Practice Address - Street 1:726 N GREENFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5061
Practice Address - Country:US
Practice Address - Phone:480-833-8620
Practice Address - Fax:480-969-3952
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2015-06-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZMD18538207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ76061Medicare ID - Type UnspecifiedMD ID GROUP ID 76060
E23900Medicare UPIN