Healthcare Provider Details

I. General information

NPI: 1902091085
Provider Name (Legal Business Name): FRANKLIN D. GAYLIS, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR SUITE 501
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: 619-463-2556
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: MRS. JEAN GAYLIS
Title or Position: EXECUTIVE SECRETARY
Credential:
Phone: 619-463-3103