Healthcare Provider Details

I. General information

NPI: 1891873709
Provider Name (Legal Business Name): GILBERT K. MORAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 MEDICAL CENTER DR. W #101
CLOVIS CA
93611
US

IV. Provider business mailing address

681 MEDICAL CENTER DR. W #101
CLOVIS CA
93611
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 NumberG64451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: