Individual
MR. DALLIN BRIM GAMBLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
380 WALKER DR, REXBURG, ID 83440-1657
(208) 356-9559
Mailing address
380 WALKER DRIVE, REXBURG, ID 83440
(208) 356-9559
(208) 356-6601
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-236
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00134875
RAILROAD MEDICARE
ID
01
—
PALDO
BLUE CROSS
ID
Enumeration date
01/16/2007
Last updated
07/09/2007
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