Entegrative Otolaryngology PC

Primary specialty

Otolaryngology/Facial Plastic Surgery PhysicianTaxonomy code 207YX0905X

License

C3527438 Issued in CA

Legal business name

ENTEGRATIVE OTOLARYNGOLOGY PC

Practice address

1144 Sonoma Ave Ste 101
Santa Rosa, CA 95405-4812

Phone

(707) 775-0775

NPI assigned

Jan 14, 2013

Last updated

Jan 14, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Larry Kyle Gambrell, D.O.

Title

Director/Ceo

Phone

(267) 456-4848

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358121600000",
    "number": "1417294174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1144 SONOMA AVE STE 101",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054812",
            "telephone_number": "707-775-0775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1144 SONOMA AVE STE 101",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054812",
            "telephone_number": "707-775-0775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENTEGRATIVE OTOLARYNGOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-14",
        "last_updated": "2013-01-14",
        "status": "A",
        "authorized_official_last_name": "GAMBRELL",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "KYLE",
        "authorized_official_title_or_position": "DIRECTOR/CEO",
        "authorized_official_telephone_number": "267-456-4848",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207YX0905X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": "CA",
            "license": "C3527438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Otolaryngology/Facial Plastic Surgery Physician in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Otolaryngology/Facial Plastic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.