DR. LARRY KYLE GAMBRELL (NPI# 1275621963) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275621963 |
| Entity Type | Individual |
| Full Name | DR. LARRY KYLE GAMBRELL |
| Credential | D.O. |
| Practice Address |
6880 Palm Avenue Sebastopol CA 95472 |
| Mailing Address |
6880 Palm Ave Sebastopol CA 95472-4270 |
| Practice Telephone | 7078237628 |
| Practice Fax Number | 7078231521 |
| Mailing Telephone | 7078237628 |
| Mailing Fax Number | 7078231521 |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2015-03-03 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YX0905X |
Otolaryngology Specialization: Otolaryngology/Facial Plastic Surgery |
20A9837 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDICARE | CA107813 | 01 |
| Street Address |
6880 PALM AVENUE |
| City | SEBASTOPOL |
| State | CA |
| Zip Code | 95472 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841256989 | Randall P Hrabko | Dermatology | 6880 Palm Avenue, Sebastopol, CA 95472 | 2006-04-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558916791 | Mellisa Nicole Elrod | Occupational Therapist | 1935 Gravenstein Hwy, Sebastopol, CA 95472 | 2019-08-05 |
| 1457820987 | Isabel Brooke Martinez | Acupuncturist | 961 Gravenstein Hwy South, # 100, Sebastopol, CA 95472 | 2018-11-14 |
| 1275025470 | Shahbano Syeda | Specialist/Technologist | 846/848 Gravenstein Hwy South, Sebastopol, CA 95472 | 2018-06-04 |
| 1467990812 | Mathew Metzgar | Marriage & Family Therapist | 1800 N. Gravenstein Hwy, Sebastopol, CA 95472 | 2017-02-06 |
| 1760939318 | Andrea Kirk | Psychologist | 876 Gravenstein Hwy S., Suite 6, Sebastopol, CA 95472 | 2016-09-01 |
| 1548629371 | Stacy Simons | Massage Therapist | 103 Morris St Ste V, Sebastopol, CA 95472 | 2016-02-22 |
| 1619341880 | Carol Schmid | Counselor | 1800 N, Gravenstein Hwy, Sebastopol, CA 95472 | 2015-11-25 |
| 1801273727 | Aaron Martinez | Specialist/Technologist | 7441 Witter Road, Sebastopol, CA 95472 | 2015-04-29 |
| 1699167049 | Nia Kaye | Marriage & Family Therapist | 130 Petaluma Ave Ste 2c, Sebastopol, CA 95472 | 2015-02-23 |
| 1497091383 | Caitlin Marie Kirkman | Midwife | 5611 Hessel Ave, Sebastopol, CA 95472 | 2012-12-20 |
| Find all providers in zip 95472 | ||||
| Taxonomy Code | 207YX0905X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Otolaryngology/Facial Plastic Surgery |
| An otolaryngologist who specializes in the diagnosis and surgical treatment of head and neck conditions. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate is issued by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073159406 | Bh Ent Group Inc | Otolaryngology | 9033 Wilshire Blvd Ste 409, Beverly Hills, CA 90211-1847 | 2019-11-20 |
| 1942719570 | Beverly Hills Head and Neck Associates | Otolaryngology | 9401 Wilshire Blvd Ste 650, Beverly Hills, CA 90212-2913 | 2017-09-27 |
| 1083135065 | Jeffrey Jumaily Md Inc | Otolaryngology | 8816 Burton Way # 1, Beverly Hills, CA 90211-1715 | 2017-06-29 |
| 1558881771 | Bel Air Surgical Institute | Otolaryngology | 11847 Wilshire Blvd Ste 302, Los Angeles, CA 90025-6634 | 2017-06-20 |
| 1912371352 | Ent Surgical Specialists Inc. | Otolaryngology | 6424 W Olympic Blvd, Los Angeles, CA 90048-5347 | 2015-11-23 |
| 1437536216 | Kiersten L. Riedler | Otolaryngology | 5405 Oberlin Dr Fl 2, San Diego, CA 92121-1700 | 2015-04-30 |
| 1114344025 | Ryan M Casserly | Otolaryngology | 966 Cass St Ste 250, Monterey, CA 93940-4541 | 2014-03-28 |
| 1558798611 | Stephen Dow Proffitt | Otolaryngology | 172 Admiral Way, Costa Mesa, CA 92627-1397 | 2013-10-03 |
| 1447693973 | Jacob Lee Wester | Otolaryngology | 200 Medical Plaza Driveway Ste 550, Ucla Department of Head and Neck Surgery, Los Angeles, CA 90095-0001 | 2013-04-15 |
| 1417294174 | Entegrative Otolaryngology PC | Otolaryngology | 1144 Sonoma Ave Ste 101, Santa Rosa, CA 95405-4812 | 2013-01-14 |
| Find all providers with the same taxonomy | ||||
| City | SEBASTOPOL |
| Zip Code | 95472 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.