Individual
MRS. MICHELE LEIGH GAMBREL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
201 OAK DR SOUTH #107, LAKE JACKSON, TX 77566-5626
(979) 297-0028
(979) 297-0504
Mailing address
201 OAK DR SOUTH #107, LAKE JACKSON, TX 77566-5626
(979) 297-0028
(979) 297-0504
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00543
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00834Y
MEDICARE GROUP NUMBER
TX
01
—
PA00543
STATE LICENSE NUMBER
TX
Enumeration date
09/12/2006
Last updated
03/26/2008
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