Provider Demographics
NPI:1922109560
Name:GISLA, JOHN F JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:GISLA
Suffix:JR
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 PRAIRIE CITY RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-9594
Practice Address - Country:US
Practice Address - Phone:916-351-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA066818OtherHEALTH NET
CA1144565OtherFIRST HEALTH
CA00A613170Medicaid
CA5506596OtherAETNA
CAMCMG127600OtherWESTERN HEALTH ADVANTAGE
CA33015OtherINTERPLAN
CA5799756OtherCIGNA
CA000810343519OtherPHCS
CA90096783OtherPACIFICARE
CA00A613170OtherBLUE SHIELD
CA1089891OtherGREAT WEST
CA1788455OtherUNITED HEALTHCARE
CAA61317OtherBLUE CROSS
CA000810343519OtherPHCS
CA066818OtherHEALTH NET