Healthcare Provider Details

I. General information

NPI: 1336459692
Provider Name (Legal Business Name): KARL J GEBHARD MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CORPORATE DR SUITE 100
LADERA RANCH CA
92694-1152
US

IV. Provider business mailing address

26131 MARGUERITE PKWY SUITE A
MISSION VIEJO CA
92692-3161
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-9112
  • Fax: 949-582-2943
Mailing address:
  • Phone: 949-582-8584
  • Fax: 949-582-2943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG80567
License Number StateCA

VIII. Authorized Official

Name: KARL J GEBHARD
Title or Position: OWNER
Credential: M.D.
Phone: 949-364-9112