Healthcare Provider Details

I. General information

NPI: 1699965962
Provider Name (Legal Business Name): HARVEY A. GILBERT, MD. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 01/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 W HAMMER LN
STOCKTON CA
95209-2839
US

IV. Provider business mailing address

311 S HAM LN
LODI CA
95242-3512
US

V. Phone/Fax

Practice location:
  • Phone: 209-365-1761
  • Fax: 209-333-3673
Mailing address:
  • Phone: 209-365-1761
  • Fax: 209-333-3673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: HARVEY A GILBERT
Title or Position: OWNER/DIRECTOR
Credential: MD
Phone: 209-365-1761