Provider Demographics
NPI:1578716288
Name:GERALD RADLAUER MD INC
Entity Type:Organization
Organization Name:GERALD RADLAUER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:RADLAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-242-5389
Mailing Address - Street 1:18564 US HIGHWAY 18 STE 105
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2320
Mailing Address - Country:US
Mailing Address - Phone:760-242-7777
Mailing Address - Fax:760-242-3927
Practice Address - Street 1:18523 CORWIN RD STE I
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2300
Practice Address - Country:US
Practice Address - Phone:760-242-5389
Practice Address - Fax:760-946-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87597207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG87597OtherCALIFORNIA MEDICAL LICENSE