Organization
ENTEGRATIVE OTOLARYNGOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARRY KYLE GAMBRELL D.O. (DIRECTOR/CEO)
(267) 456-4848
Entity
Organization
Contact information
Practice address
1144 SONOMA AVE STE 101, SANTA ROSA, CA 95405-4812
(707) 775-0775
Mailing address
1144 SONOMA AVE STE 101, SANTA ROSA, CA 95405-4812
(707) 775-0775
Taxonomy
Speciality
Code
Description
License number
State
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
C3527438
CA
Other
Enumeration date
01/14/2013
Last updated
01/14/2013
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