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General NPI Number Information
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NPI Number | 1558350272
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Entity Type | Individual
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Provider Name | GERARD S ISSVORAN DO
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Gender | Male
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Dates
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Enumeration Date | 10/14/2005
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 24551 SILVER CLOUD CT STE 201
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City | MONTEREY
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State | CA
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Zip | 93940-6532
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Country | US
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Telephone | 831-333-2100
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Fax | 831-333-2105
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Provider Business Mailing Address
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Address Line | 395 DEL MONTE CTR # 360-B
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City | MONTEREY
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State | CA
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Zip | 93940-6156
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Country | US
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Telephone | 831-333-2100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 20A6978
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License Number State | CA
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