Provider Demographics
NPI:1619147899
Name:GIL S PARK, MD, INC
Entity Type:Organization
Organization Name:GIL S PARK, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GIL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-324-0300
Mailing Address - Street 1:3200 21ST ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3144
Mailing Address - Country:US
Mailing Address - Phone:661-324-0300
Mailing Address - Fax:661-324-4095
Practice Address - Street 1:6000 PHYSICIANS BLVD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5840
Practice Address - Country:US
Practice Address - Phone:661-322-4744
Practice Address - Fax:661-322-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAA31383207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A313830Medicaid
CABH900AMedicare PIN
CAA87566Medicare UPIN
CA00A313830Medicare PIN
CA050079629Medicare PIN