Provider Demographics
NPI:1841380656
Name:PAUL, GERALD ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:ROBERT
Last Name:PAUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 TRUXTUN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6135
Mailing Address - Country:US
Mailing Address - Phone:619-610-9790
Mailing Address - Fax:619-610-9765
Practice Address - Street 1:3405 KENYON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5004
Practice Address - Country:US
Practice Address - Phone:619-222-2335
Practice Address - Fax:619-222-2066
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A196470208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A196470Medicaid
A82087Medicare UPIN
A19647Medicare ID - Type Unspecified