Provider Demographics
NPI:1447232988
Name:GIL, LISA M (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:GIL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1317 OAKDALE RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3361
Mailing Address - Country:US
Mailing Address - Phone:209-869-5678
Mailing Address - Fax:209-869-7657
Practice Address - Street 1:2603 PATTERSON RD STE 1
Practice Address - Street 2:
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-3407
Practice Address - Country:US
Practice Address - Phone:209-869-5678
Practice Address - Fax:209-869-7657
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2015-04-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA74592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A745920OtherBLUE SHIELD OF CA PIN
CAH78760Medicare UPIN
CAH78760Medicare UPIN
CA00A745920Medicare ID - Type Unspecified