Provider Demographics
NPI:1689759805
Name:WESTERN GASTROENTEROLOGISTS
Entity Type:Organization
Organization Name:WESTERN GASTROENTEROLOGISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:B
Authorized Official - Last Name:ECKERLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-727-1232
Mailing Address - Street 1:15825 LAGUNA CANYON RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2125
Mailing Address - Country:US
Mailing Address - Phone:949-727-1232
Mailing Address - Fax:949-727-9615
Practice Address - Street 1:15825 LAGUNA CANYON RD
Practice Address - Street 2:SUITE 108
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2125
Practice Address - Country:US
Practice Address - Phone:949-727-1232
Practice Address - Fax:949-727-9615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE90335Medicare UPIN
CAW14239Medicare ID - Type Unspecified
CAA49536Medicare UPIN
CAA24325Medicare UPIN