Provider Demographics
NPI:1558350272
Name:ISSVORAN, GERARD S (DO)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:S
Last Name:ISSVORAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:395 DEL MONTE CTR # 360-B
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6156
Mailing Address - Country:US
Mailing Address - Phone:831-333-2100
Mailing Address - Fax:
Practice Address - Street 1:24551 SILVER CLOUD CT STE 201
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6532
Practice Address - Country:US
Practice Address - Phone:831-333-2100
Practice Address - Fax:831-333-2105
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2014-11-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH02797Medicare UPIN