Provider Demographics
NPI:1225292725
Name:RONALD M GEMBERLING MD INC
Entity Type:Organization
Organization Name:RONALD M GEMBERLING MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:GEMBERLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-544-7744
Mailing Address - Street 1:2209 SOUTH AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7037
Mailing Address - Country:US
Mailing Address - Phone:530-544-7744
Mailing Address - Fax:530-544-5593
Practice Address - Street 1:2209 SOUTH AVE
Practice Address - Street 2:SUITE D
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7037
Practice Address - Country:US
Practice Address - Phone:530-544-7744
Practice Address - Fax:530-544-5593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26040208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A260400Medicare PIN
CAA24686Medicare UPIN