Healthcare Provider Details

I. General information

NPI: 1457549941
Provider Name (Legal Business Name): MICHAEL OWEN GADSBY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8717 LA TIJERA BLVD
LOS ANGELES CA
90045-3906
US

IV. Provider business mailing address

8717 LA TIJERA BLVD
LOS ANGELES CA
90045-3906
US

V. Phone/Fax

Practice location:
  • Phone: 310-674-2895
  • Fax:
Mailing address:
  • Phone: 213-505-4556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG77223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: