Basic Information
| Provider Information | |||||||||
| NPI: | 1952316812 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GERARD BAZILE MD A PROFESSIONAL MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1770 | ||||||||
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| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919441770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194641165 | ||||||||
| FaxNumber: | 6195671011 | ||||||||
| Practice Location | |||||||||
| Address1: | 6699 ALVARADO RD | ||||||||
| Address2: | SUITE 2306 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921205238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192860100 | ||||||||
| FaxNumber: | 6192860600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 07/11/2014 | ||||||||
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| AuthorizedOfficialLastName: | BAZILE | ||||||||
| AuthorizedOfficialFirstName: | GERARD | ||||||||
| AuthorizedOfficialMiddleName: | IRVELT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6192860100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.