MEDICARE: DR. ROBERT O. GINGERY 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	2086S0129X	Vascular Surgery Physician	G23370	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1417974460	OTHER	CA	MEDICARE NPI #

General Provider Information

NPI Number	:	1417974460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT O. GINGERY M.D.

Provider Business Mailing Address
First Line	:	13851 E 14TH ST
Second Line	:	SUITE 202
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2631
Country	:	US
Telephone Number	:	510-347-4700
Fax Number	:	510-347-4712

Provider Business Practice Location Address
First Line	:	13851 E 14TH ST
Second Line	:	SUITE 202
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2627
Country	:	US
Telephone Number	:	510-347-4700
Fax Number	:	510-347-4712

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

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	09/27/2012

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