Provider Demographics
NPI:1093767972
Name:GAMBOA, GLORIA DANIELLE (MD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:DANIELLE
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GLORIA DANIELLE
Other - Middle Name:GAMBOA
Other - Last Name:PARSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 560276
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-0276
Mailing Address - Country:US
Mailing Address - Phone:214-514-6942
Mailing Address - Fax:877-290-8920
Practice Address - Street 1:103 MCKINNEY ST
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75442-2213
Practice Address - Country:US
Practice Address - Phone:972-782-7430
Practice Address - Fax:972-782-7460
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX047160904Medicaid
G33711Medicare UPIN
TX612423Medicare PIN