Individual
MISS LISA LYNELLE GAMBLE
Active
Individual
MISS LISA LYNELLE GAMBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
23658
LA
207RP1001X
Pulmonary Disease Physician
23658
LA
207RP1001X
Pulmonary Disease Physician
Primary
Q0047
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09050308
—
MS
05
—
1484164
—
LA
05
—
369671801
—
TX
01
—
752616977042
TRICARE
TX
01
—
8GM927
BCBS
TX
01
—
P01831137
MEDICARE RAIL ROAD
TX
Enumeration date
08/10/2006
Last updated
06/12/2017
Update your record
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