Healthcare Provider Details

I. General information

NPI: 1881048882
Provider Name (Legal Business Name): GERALD POGORILER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2016
Last Update Date: 04/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 LAMBETH WAY
CARMICHAEL CA
95608-5567
US

IV. Provider business mailing address

2100 LAMBETH WAY
CARMICHAEL CA
95608-5567
US

V. Phone/Fax

Practice location:
  • Phone: 916-489-4443
  • Fax:
Mailing address:
  • Phone: 916-489-4443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG50651
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: