Individual
DAVID ALLEN GAMMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3296 RIDGECANE RD, LEXINGTON, KY 40513-1078
(859) 312-3377
Mailing address
3296 RIDGECANE RD, LEXINGTON, KY 40513-1078
(859) 312-3377
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
22708
KY
207RA0401X
Addiction Medicine (Internal Medicine) Physician
22708
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110036800
RR MEDICARE PIN NO
KY
01
—
36000818
ASC MEDICAID GROUP
KY
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
05
—
64227085
—
KY
01
—
ASC1019
ASC MEDICARE GROUP
KY
01
—
CB5773
RR MEDICARE GROUP
KY
Enumeration date
07/11/2006
Last updated
06/13/2015
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