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General NPI Number Information
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NPI Number | 1235642588
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Entity Type | Organization
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Legal Business Name | GILL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 11/08/2017
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Last Update Date | 12/11/2017
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Provider Practice Location Address
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Address Line | 999 S FAIRMONT AVE STE 235
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City | LODI
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State | CA
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Zip | 95240-5100
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Country | US
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Telephone | 209-334-0799
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2597
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City | LODI
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State | CA
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Zip | 95241-2597
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Country | US
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Telephone | 209-334-6583
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RUBY KAUR SRAO
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Credential | MD
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Telephone | 209-334-0799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A131215
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License Number State | CA
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