Individual
DR. LARA JAE GAMELIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2400 NW KINGS BLVD, CORVALLIS, OR 97330-3900
(541) 757-2400
(541) 752-0931
Mailing address
2400 NW KINGS BLVD, CORVALLIS, OR 97330-3900
(541) 757-2400
(541) 752-0931
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD19740
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078225
—
OR
01
—
931288530
TAX OR BUSINESS ID NUMBER
OR
Enumeration date
11/09/2006
Last updated
08/12/2024
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