MEDICARE: TIM GURTCH, MD, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0505X	Adult Medicine Physician	C50806	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174713945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIM GURTCH, MD, INC.

Provider Business Mailing Address
First Line	:	4276 54TH PL STE A
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-6011
Country	:	US
Telephone Number	:	619-265-1070
Fax Number	:	619-265-1454

Provider Business Practice Location Address
First Line	:	3636 N 1ST ST STE 165
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93726-6818
Country	:	US
Telephone Number	:	559-222-3237
Fax Number	:	559-222-3270

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TIM PLATON GURTCH
Credential	:	MD
Telephone Number	:	619-265-1070

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	06/30/2008

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