Provider Demographics
NPI:1487665535
Name:MALLARD-WARREN, GAIL MAUREEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:MAUREEN
Last Name:MALLARD-WARREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 N 1ST ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5460
Mailing Address - Country:US
Mailing Address - Phone:559-432-5697
Mailing Address - Fax:559-432-5699
Practice Address - Street 1:6107 N 1ST ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5460
Practice Address - Country:US
Practice Address - Phone:559-432-5697
Practice Address - Fax:559-432-5699
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42804207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
9483815Medicare UPIN
CA00G428040Medicare ID - Type Unspecified