Provider Demographics
NPI:1013148857
Name:SEARLE, GERALD LANE (DO)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:LANE
Last Name:SEARLE
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3746 FOOTHILL BLVD # B140
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1740
Mailing Address - Country:US
Mailing Address - Phone:310-445-5999
Mailing Address - Fax:
Practice Address - Street 1:3746 FOOTHILL BLVD # B140
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91214-1740
Practice Address - Country:US
Practice Address - Phone:310-445-5999
Practice Address - Fax:323-544-4248
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO 3255207Q00000X
CA13293208D00000X
NVSL0670174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist