Provider Demographics
NPI:1801897806
Name:BRUCE M. GACH, M.D., INC.
Entity type:Organization
Organization Name:BRUCE M. GACH, M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-455-5050
Mailing Address - Street 1:1133 E STANLEY BLVD
Mailing Address - Street 2:#103
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4200
Mailing Address - Country:US
Mailing Address - Phone:925-455-5050
Mailing Address - Fax:925-455-6560
Practice Address - Street 1:1133 E STANLEY BLVD
Practice Address - Street 2:#103
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4200
Practice Address - Country:US
Practice Address - Phone:925-455-5050
Practice Address - Fax:925-455-6560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21896174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41416Medicare UPIN