Provider Demographics
NPI:1578276515
Name:G&L MEDICAL LLC
Entity Type:Organization
Organization Name:G&L MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY MEDICINE PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-259-1995
Mailing Address - Street 1:401 BOTULPH LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6912
Mailing Address - Country:US
Mailing Address - Phone:631-259-1995
Mailing Address - Fax:
Practice Address - Street 1:401 BOTULPH LN
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6912
Practice Address - Country:US
Practice Address - Phone:631-259-1995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty