Provider Demographics
NPI:1881967172
Name:BRETT ANDREW GIDNEY MEDICAL CORPORATION
Entity type:Organization
Organization Name:BRETT ANDREW GIDNEY MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GIDNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-845-5305
Mailing Address - Street 1:504 W PUEBLO ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-6211
Mailing Address - Country:US
Mailing Address - Phone:805-845-5305
Mailing Address - Fax:805-845-6435
Practice Address - Street 1:504 W PUEBLO ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6211
Practice Address - Country:US
Practice Address - Phone:805-845-5305
Practice Address - Fax:805-845-6453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81336207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FV768AMedicare UPIN