Provider Demographics
NPI:1932264801
Name:TIM GURTCH MD, INC.
Entity Type:Organization
Organization Name:TIM GURTCH MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:PLATON
Authorized Official - Last Name:GURTCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-425-5228
Mailing Address - Street 1:4276 54TH PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6011
Mailing Address - Country:US
Mailing Address - Phone:619-265-1070
Mailing Address - Fax:619-265-1454
Practice Address - Street 1:4276 54-TH PLACE
Practice Address - Street 2:SUITE A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115
Practice Address - Country:US
Practice Address - Phone:619-265-1070
Practice Address - Fax:619-265-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0102270Medicaid
CAW19288Medicare ID - Type UnspecifiedMEDICARE GROOP ID
CAGR0102270Medicaid