Provider Demographics
NPI:1134327349
Name:JOHN F GEBHARD MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JOHN F GEBHARD MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GEBHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-540-7546
Mailing Address - Street 1:217 AVENIDA DEL NORTE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5702
Mailing Address - Country:US
Mailing Address - Phone:310-540-7546
Mailing Address - Fax:310-540-1056
Practice Address - Street 1:217 AVENIDA DEL NORTE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5702
Practice Address - Country:US
Practice Address - Phone:310-540-7546
Practice Address - Fax:310-540-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27106207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW4378Medicare PIN