Provider Demographics
NPI:1881694776
Name:GURTCH, TIM PLATON (MD)
Entity type:Individual
Prefix:DR
First Name:TIM
Middle Name:PLATON
Last Name:GURTCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8875 LA MESA BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-5434
Mailing Address - Country:US
Mailing Address - Phone:619-668-8100
Mailing Address - Fax:619-667-2688
Practice Address - Street 1:4276 54TH PL
Practice Address - Street 2:STE A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-6011
Practice Address - Country:US
Practice Address - Phone:619-265-1070
Practice Address - Fax:619-265-1454
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2018-02-01
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CAC50806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG57716Medicare UPIN