Provider Demographics
NPI:1417974460
Name:GINGERY, ROBERT O (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:O
Last Name:GINGERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13851 E 14TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2631
Mailing Address - Country:US
Mailing Address - Phone:510-347-4700
Mailing Address - Fax:510-347-4712
Practice Address - Street 1:13851 E 14TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2627
Practice Address - Country:US
Practice Address - Phone:510-347-4700
Practice Address - Fax:510-347-4712
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG233702086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1417974460OtherMEDICARE NPI #
CA00G23702Medicare PIN
CACS319XMedicare PIN
CACS319ZMedicare PIN
CAZZZ99493ZMedicare PIN
CA1417974460OtherMEDICARE NPI #
CAA41930Medicare UPIN
CACR0889Medicare PIN
CACS319YMedicare PIN
CAZZZ15705ZMedicare PIN
CAZZZ94434ZMedicare PIN
CAZZZ29924ZMedicare PIN