MEDICARE: DR. GIL TEPPER 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	207XS0117X	Orthopaedic Surgery of the Spine Physician	G68053	CA

General Provider Information

NPI Number	:	1821147976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GIL TEPPER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 19070
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91416-9070
Country	:	US
Telephone Number	:	818-990-4100
Fax Number	:	818-990-4166

Provider Business Practice Location Address
First Line	:	4849 VAN NUYS BLVD
Second Line	:	SUITE 217
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-2110
Country	:	US
Telephone Number	:	818-990-4100
Fax Number	:	818-990-4166

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	01/26/2015

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