Basic Information
Provider Information
NPI: 1407081342
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GILL
FirstName: FIRDOSE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4910 E CLINTON WAY
Address2: SUITE 101
City: FRESNO
State: CA
PostalCode: 937271560
CountryCode: US
TelephoneNumber: 5594432682
FaxNumber: 5594432681
Practice Location
Address1: 2823 FRESNO ST
Address2:  
City: FRESNO
State: CA
PostalCode: 937211324
CountryCode: US
TelephoneNumber: 5594996493
FaxNumber: 5594996501
Other Information
ProviderEnumerationDate: 05/21/2009
LastUpdateDate: 03/15/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X20A10782CAN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000X20A10782CAY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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