Provider Demographics
NPI:1881066926
Name:KARL GEBHARD MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:KARL GEBHARD MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:GEBHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-302-9771
Mailing Address - Street 1:26922 OSO PARKWAY
Mailing Address - Street 2:SUITE 380
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-305-0110
Mailing Address - Fax:949-305-0101
Practice Address - Street 1:26922 OSO PKWY
Practice Address - Street 2:STE 380
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5800
Practice Address - Country:US
Practice Address - Phone:949-305-0110
Practice Address - Fax:949-305-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-28
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG080567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty