Provider Demographics
NPI:1982032603
Name:GERALD BUCKBERG M.D. INC
Entity Type:Organization
Organization Name:GERALD BUCKBERG M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BUCKBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-206-1027
Mailing Address - Street 1:UCLA MEDICAL CTR
Mailing Address - Street 2:10833 LE CONTE AVENUE 62-258 CHS
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1741
Mailing Address - Country:US
Mailing Address - Phone:310-206-1027
Mailing Address - Fax:
Practice Address - Street 1:UCLA MEDICAL CTR
Practice Address - Street 2:10833 LE CONTE AVENUE 62-258 CHS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1741
Practice Address - Country:US
Practice Address - Phone:310-206-1027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG11527305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service