Provider Demographics
NPI:1639187552
Name:SHERGILL, HARBHAJAN SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:HARBHAJAN
Middle Name:SINGH
Last Name:SHERGILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5345 N EL DORADO
Mailing Address - Street 2:#3
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5848
Mailing Address - Country:US
Mailing Address - Phone:209-478-4041
Mailing Address - Fax:209-478-4084
Practice Address - Street 1:2701 E HAMMER LN
Practice Address - Street 2:STE 103
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-4245
Practice Address - Country:US
Practice Address - Phone:209-320-2650
Practice Address - Fax:209-320-2653
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31635208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A216350Medicaid
00A316350Medicare ID - Type Unspecified
CA00A216350Medicaid