Provider Demographics
NPI:1861694010
Name:GAMBLE, TERREZE MONROZE (MD)
Entity type:Individual
Prefix:
First Name:TERREZE
Middle Name:MONROZE
Last Name:GAMBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12427
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-2427
Mailing Address - Country:US
Mailing Address - Phone:850-402-6210
Mailing Address - Fax:850-325-6015
Practice Address - Street 1:1803 MICCOSUKEE COMMONS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-7403
Practice Address - Country:US
Practice Address - Phone:850-402-6210
Practice Address - Fax:850-325-6015
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102897207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01153560OtherMEDICARE RAILROAD
FL000613100Medicaid
FLP01153560OtherMEDICARE RAILROAD