Provider Demographics
NPI:1992876205
Name:GAMBILL, ALAN LEE (STATE LICENSED HAD)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:LEE
Last Name:GAMBILL
Suffix:
Gender:M
Credentials:STATE LICENSED HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 S STATE ROAD 135
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1421
Mailing Address - Country:US
Mailing Address - Phone:317-865-7676
Mailing Address - Fax:317-865-7674
Practice Address - Street 1:239 S STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1421
Practice Address - Country:US
Practice Address - Phone:317-865-7676
Practice Address - Fax:317-865-7674
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001222A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000346775OtherANTHEM PROVIDER NUMBER