Basic Information
| Provider Information | |||||||||
| NPI: | 1497774947 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEHRET | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 OLD NEWPORT BLVD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926634289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499992977 | ||||||||
| FaxNumber: | 9499992969 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 OLD NEWPORT BLVD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926634289 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499992977 | ||||||||
| FaxNumber: | 9499992969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 04/19/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | G48231 | CA | N | Other Service Providers | Specialist | 2084N0400X | G48231 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.