Basic Information
Provider Information
NPI: 1003006149
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GAMBOA
FirstName: STEPHEN
MiddleName: H
NamePrefix: DR.
NameSuffix:  
Credential: M.D., M.P.H.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: UNIVERSITY OF NORTH CAROLINA
Address2: 590 MANNING DR, CB #7595
City: CHAPEL HILL
State: NC
PostalCode: 275990001
CountryCode: US
TelephoneNumber: 9199662236
FaxNumber: 9199666125
Practice Location
Address1: UNC DEPT OF FAMILY MEDICINE
Address2: 590 MANNING DR, CB #7595
City: CHAPEL HILL
State: NC
PostalCode: 275990001
CountryCode: US
TelephoneNumber: 9199662236
FaxNumber: 9199666125
Other Information
ProviderEnumerationDate: 07/25/2007
LastUpdateDate: 04/05/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000XA93276CAN Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000X2008-01775NCY Allopathic & Osteopathic PhysiciansFamily Medicine 
207Q00000X232725MAN Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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