Individual
JOHN E GAMBOA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9357 W EMERALD ST, BOISE, ID 83704-9752
(208) 672-1000
Mailing address
9357 W EMERALD ST, BOISE, ID 83704-9752
(208) 672-1000
(208) 672-1010
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
M5607
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002745400
—
ID
Enumeration date
06/15/2006
Last updated
02/20/2018
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