Healthcare Provider Details

I. General information

NPI: 1689191611
Provider Name (Legal Business Name): GEM PHYSICIANS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2017
Last Update Date: 10/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 SAN DIMAS ST STE 101
BAKERSFIELD CA
93301-5733
US

IV. Provider business mailing address

4550 CALIFORNIA AVE STE 610
BAKERSFIELD CA
93309-7012
US

V. Phone/Fax

Practice location:
  • Phone: 661-716-7100
  • Fax:
Mailing address:
  • Phone: 661-716-7100
  • Fax: 661-716-5484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES VINCENT PHILLIPS
Title or Position: OWNER
Credential: MD
Phone: 661-665-0505