Provider Demographics
NPI:1669427506
Name:CASTLE ROCK MEDICAL GROUP
Entity type:Organization
Organization Name:CASTLE ROCK MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:GERTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-565-6000
Mailing Address - Street 1:8705 COMPLEX DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1401
Mailing Address - Country:US
Mailing Address - Phone:858-565-6000
Mailing Address - Fax:858-627-0050
Practice Address - Street 1:8705 COMPLEX DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1401
Practice Address - Country:US
Practice Address - Phone:858-565-6000
Practice Address - Fax:858-627-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18048Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION N