MR. DALLIN BRIM GAMBLES (NPI# 1760533400) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760533400 |
| Entity Type | Individual |
| Full Name | MR. DALLIN BRIM GAMBLES |
| Credential | PA |
| Practice Address |
380 Walker Dr Rexburg ID 83440-1657 |
| Mailing Address |
380 Walker Drive Rexburg ID 83440 |
| Practice Telephone | 2083569559 |
| Mailing Telephone | 2083569559 |
| Mailing Fax Number | 2083566601 |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA-236 | ID | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | BLUE CROSS | PALDO | 01 |
| ID | RAILROAD MEDICARE | P00134875 | 01 |
| Street Address |
380 WALKER DR |
| City | REXBURG |
| State | ID |
| Zip Code | 83440-1657 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578807996 | Teton Cancer Institute | Durable Medical Equipment & Medical Supplies | 380 Walker Dr, Rexburg, ID 83440-1657 | 2012-11-26 |
| 1265637573 | Jeffrey D Hancock | Pediatrics | 380 Walker Dr, Rexburg, ID 83440-1657 | 2007-06-18 |
| 1245382985 | Teton Oncology LLC | Internal Medicine | 380 Walker Dr, Rexburg, ID 83440-1657 | 2007-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235768490 | Henry's Fork Surgery Center Pllc | Clinic/Center | 23 Sawtelle Ave, Rexburg, ID 83440 | 2020-04-08 |
| 1952956906 | Shane Ellis Withers | Pharmacist | 164 E. Main, Rexburg, ID 83440 | 2019-08-06 |
| 1316392285 | Emma Anderson | Speech-Language Pathologist | 36 Professional Plaza Suite 110, Rexburg, ID 83440 | 2016-04-28 |
| 1851755524 | Sandra Frickey | Speech-Language Pathologist | 1087 Summers Drive, Premier Therapy Associates, Rexburg, ID 83440 | 2016-04-08 |
| 1275997215 | Kerry Denney | Counselor | 333 Walker Drive, Rexburg, ID 83440 | 2016-04-06 |
| 1467837583 | Wal-mart Stores, Inc. | Technician/Technologist | 303 E Moody Rd, Rexburg, ID 83440 | 2015-07-30 |
| 1649692609 | Tanabell Health Services, Inc. | Skilled Nursing Facility | 410 W 1st N, Rexburg, ID 83440 | 2014-01-10 |
| 1043652571 | Creed Simon Webster | Counselor | 30 S 2nd W, Rexburg, ID 83440 | 2013-07-25 |
| 1033461660 | James Cannon Allen Dds PC | Dentist | 106 E 1st North, Rexburg, ID 83440 | 2012-10-05 |
| 1417217316 | Shelby Dee Woolstenhulme | Speech-Language Pathologist | 450 E. Main Street, Rexburg, ID 83440 | 2012-05-24 |
| Find all providers in zip 83440 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629247093 | Fall Creek Skin and Health Pllc | Physician Assistant | 534 Trejo St Ste 400, Rexburg, ID 83440 | 2008-02-29 |
| 1932254133 | Brett Gerald Bagley | Physician Assistant | 556 Trejo St, Suite B, Rexburg, ID 83440 | 2007-01-25 |
| 1780691394 | Christina Goodman | Physician Assistant | 100 Student Health Center Building, Rexburg, ID 83440 | 2006-08-03 |
| 1184122756 | Steven Craig Pierce | Physician Assistant | 450 E Main St, Rexburg, ID 83440-2048 | 2018-01-29 |
| 1114297660 | Janiel J Green | Physician Assistant | 36 Professional Plz, Suite #102, Rexburg, ID 83440-2049 | 2011-12-30 |
| 1780965038 | Rex Allen Meredith | Physician Assistant | 37 S 2nd E, Rexburg, ID 83440-1906 | 2011-08-31 |
| 1972770881 | Greg Lyle Klingler | Physician Assistant | 32 W 1st S, Rexburg, ID 83440-1810 | 2008-05-09 |
| 1609998731 | Mark S. Hammar | Physician Assistant | 36 Professional Plz, Suite 202, Rexburg, ID 83440-2049 | 2007-04-06 |
| 1447296785 | Zachery M Brunson | Physician Assistant | 393 E 2nd N, Rexburg, ID 83440 | 2006-06-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689217911 | David Jeffrey Hanson | Physician Assistant | 740 Mckinley Ave Ste 100, Kellogg, ID 83837-2693 | 2019-10-18 |
| 1871060681 | Travis Henman | Physician Assistant | 1404 Pomerelle Ave Ste 150, Burley, ID 83318-2012 | 2018-10-30 |
| 1952889685 | Cody Mattingly | Physician Assistant | 14601 S Pleasant Valley Rd, Kuna, ID 83634-2728 | 2018-08-03 |
| 1992174072 | Alexa Rhea | Physician Assistant | 2841 Juniper Dr Ste 2, Lewiston, ID 83501-4719 | 2015-09-18 |
| 1043689441 | Derek R Wynn | Physician Assistant | 607 W Main Street, Grangeville, ID 83530 | 2015-09-16 |
| 1407223274 | Michael Kenneth Wucinich | Physician Assistant | 775 Pole Line Rd W Ste 302, Twin Falls, ID 83301-5823 | 2015-08-28 |
| 1811364177 | Ashley Laren Popadics | Physician Assistant | 1510 12th Ave Rd Ste 200, Nampa, ID 83686-6008 | 2015-08-21 |
| 1073915963 | Jessica Bishop | Physician Assistant | 1499 W Hays St, Boise, ID 83702-5029 | 2014-09-23 |
| 1447652813 | Jessea Camille Whitlow | Physician Assistant | 2392 Addison Ave E, Twin Falls, ID 83301-6745 | 2014-09-17 |
| 1508287061 | Heather N Fox | Physician Assistant | 12273 West Mcmillan Road, Boise, ID 83713 | 2013-12-30 |
| Find all providers with the same taxonomy | ||||
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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.