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General NPI Number Information
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NPI Number | 1023102969
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Entity Type | Organization
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Legal Business Name | GASTROINTESTINAL ASSOC A MEDICAL GROUP INC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 555 E TACHEVAH DR SUITE #1E-104
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City | PALM SPRINGS
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State | CA
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Zip | 92262-5750
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Country | US
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Telephone | 760-325-7601
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Fax | 760-325-4281
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Provider Business Mailing Address
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Address Line | 555 E TACHEVAH DR #1E-104
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City | PALM SPRINGS
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State | CA
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Zip | 92262-5750
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRIAN M CLEARY
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Credential | MD
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Telephone | 760-325-7601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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