Healthcare Provider Details

I. General information

NPI: 1689759805
Provider Name (Legal Business Name): WESTERN GASTROENTEROLOGISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15825 LAGUNA CANYON RD SUITE 108
IRVINE CA
92618-2125
US

IV. Provider business mailing address

15825 LAGUNA CANYON RD SUITE 108
IRVINE CA
92618-2125
US

V. Phone/Fax

Practice location:
  • Phone: 949-727-1232
  • Fax: 949-727-9615
Mailing address:
  • Phone: 949-727-1232
  • Fax: 949-727-9615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GORDON B ECKERLING
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-727-1232