Provider Demographics
NPI:1285824532
Name:HARVEY A GILBERT, MD, INC
Entity Type:Organization
Organization Name:HARVEY A GILBERT, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-365-1761
Mailing Address - Street 1:311 S HAM LN
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3512
Mailing Address - Country:US
Mailing Address - Phone:209-365-1761
Mailing Address - Fax:209-333-3673
Practice Address - Street 1:601 COURT ST
Practice Address - Street 2:#150
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2160
Practice Address - Country:US
Practice Address - Phone:209-365-1761
Practice Address - Fax:209-333-3673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A923390Medicaid
CAGR0103050Medicaid
CA00C283720Medicaid
ZZZ02276ZMedicare PIN
CAGR0103050Medicaid
00C283721Medicare PIN