Healthcare Provider Details

I. General information

NPI: 1376859223
Provider Name (Legal Business Name): GILBERT K. MORAN M.D. F.A.C.O.G. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2010
Last Update Date: 08/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 MEDICAL CENTER DR W STE 101
CLOVIS CA
93611-6803
US

IV. Provider business mailing address

681 MEDICAL CENTER DR W STE 101
CLOVIS CA
93611-6803
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-9000
  • Fax: 559-299-8581
Mailing address:
  • Phone: 559-299-9000
  • Fax: 559-299-8581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG64415
License Number StateCA

VIII. Authorized Official

Name: DR. GILBERT K MORAN
Title or Position: PRESIDENT
Credential: MD
Phone: 559-299-9000