MEDICARE: DR. GERALD LEE SAKS M.D.

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	261QS1000X	Student Health Clinic/Center	G9945	CA

General Provider Information

NPI Number	:	1184830713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD LEE SAKS M.D.

Provider Business Mailing Address
First Line	:	5929 INTERVALE DR
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-4050
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5700 ARLINGTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2035
Country	:	US
Telephone Number	:	951-274-4213
Fax Number	:	951-274-4203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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