MEDICARE: DR. GERALD R KLAUCK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G68580	CA

General Provider Information

NPI Number	:	1588876452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD R KLAUCK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 33345
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92163-3345
Country	:	US
Telephone Number	:	619-723-1728
Fax Number	:	866-439-0552

Provider Business Practice Location Address
First Line	:	1625 HOTEL CIR S
Second Line	:	UNIT C-108
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3302
Country	:	US
Telephone Number	:	619-723-1728
Fax Number	:	866-439-0552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2007
Last Update Date	:	08/19/2008

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