Healthcare Provider Details

I. General information

NPI: 1013148857
Provider Name (Legal Business Name): GERALD LANE SEARLE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3746 FOOTHILL BLVD # B140
GLENDALE CA
91214-1740
US

IV. Provider business mailing address

3746 FOOTHILL BLVD # B140
GLENDALE CA
91214-1740
US

V. Phone/Fax

Practice location:
  • Phone: 310-445-5999
  • Fax: 323-544-4248
Mailing address:
  • Phone: 310-445-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberUO 3255
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13293
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberSL0670
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: