Provider Demographics
NPI:1891873709
Name:MORAN, GILBERT K (MD)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:K
Last Name:MORAN
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 1:681 MEDICAL CENTER DR. W
Mailing Address - Street 2:#101
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611
Mailing Address - Country:US
Mailing Address - Phone:559-299-9000
Mailing Address - Fax:559-299-8581
Practice Address - Street 1:681 MEDICAL CENTER DR. W
Practice Address - Street 2:#101
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611
Practice Address - Country:US
Practice Address - Phone:559-299-9000
Practice Address - Fax:559-299-8581
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64451207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G644510Medicaid
00G644510Medicare ID - Type Unspecified
CA00G644510Medicaid
CAF11755Medicare UPIN