Provider Demographics
NPI:1205009461
Name:G.B. HAERI M D INC
Entity Type:Organization
Organization Name:G.B. HAERI M D INC
Other - Org Name:GHOL B HAERI-GHARAVI M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GHOL
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAERI-GHARAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-335-7755
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-0022
Mailing Address - Country:US
Mailing Address - Phone:661-335-7755
Mailing Address - Fax:661-335-7766
Practice Address - Street 1:4545 STOCKDALE HWY STE A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2024
Practice Address - Country:US
Practice Address - Phone:661-834-4812
Practice Address - Fax:661-335-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38702207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447220017OtherINDIVIDUAL NPI
CA00A387020Medicare PIN