Provider Demographics
NPI:1194733774
Name:GEMBS, EDUARDO A (MD)
Entity type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:A
Last Name:GEMBS
Suffix:
Gender:M
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 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:704-246-2777
Mailing Address - Fax:704-246-2788
Practice Address - Street 1:6030 W HIGHWAY 74
Practice Address - Street 2:SUITE A
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-3468
Practice Address - Country:US
Practice Address - Phone:704-246-2777
Practice Address - Fax:704-246-2788
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042734207Q00000X
NC2013-01784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1194733774Medicaid
WA8369621Medicaid
NC1194733774Medicaid
NCNCF928CMedicare PIN
NCNCF928AMedicare PIN
NCNCF928DMedicare PIN
WA8808913Medicare PIN
WA8369621Medicaid
NCNCF928EMedicare PIN