Healthcare Provider Details

I. General information

NPI: 1174530042
Provider Name (Legal Business Name): GERALD FRANCIS WAHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 SAN JOSE ST
SALINAS CA
93901
US

IV. Provider business mailing address

220 SAN JOSE ST
SALINAS CA
93901
US

V. Phone/Fax

Practice location:
  • Phone: 831-424-0807
  • Fax: 831-424-3408
Mailing address:
  • Phone: 831-424-0807
  • Fax: 831-424-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG215420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: