Basic Information
| Provider Information | |||||||||
| NPI: | 1518975366 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GAMMACK | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1008 S SPRING AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631102520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149778462 | ||||||||
| FaxNumber: | 3149773370 | ||||||||
| Practice Location | |||||||||
| Address1: | CENTER FOR SPECIALIZED MEDICINE | ||||||||
| Address2: | 1221 S. GRAND BLVD, 2ND FLOOR | ||||||||
| City: | ST LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149776055 | ||||||||
| FaxNumber: | 3149773370 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 2003020128 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.