Healthcare Provider Details

I. General information

NPI: 1750360806
Provider Name (Legal Business Name): FRANKLIN D. GAYLIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR
LA MESA CA
91942-3017
US

IV. Provider business mailing address

PO BOX 33865
SAN DIEGO CA
92163-3865
US

V. Phone/Fax

Practice location:
  • Phone: 619-697-2456
  • Fax: 858-429-7930
Mailing address:
  • Phone: 858-888-7700
  • Fax: 858-888-7721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA46251
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: