Individual
SHANE GAMBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RD
Contact information
Practice address
913 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471-6523
(541) 440-1000
Mailing address
1025 NW BASCO AVE, ROSEBURG, OR 97471-6164
(774) 217-0722
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
4758
MA
133V00000X
Registered Dietitian
Primary
86058164
—
Other
Enumeration date
08/28/2020
Last updated
08/28/2020
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