MEDICARE: DR. GERARD S ISSVORAN DO

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	207Q00000X	Family Medicine Physician	20A6978	CA

General Provider Information

NPI Number	:	1558350272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD S ISSVORAN DO

Provider Business Mailing Address
First Line	:	395 DEL MONTE CTR # 360-B
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-6156
Country	:	US
Telephone Number	:	831-333-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	24551 SILVER CLOUD CT STE 201
Second Line	:
City	:	MONTEREY
State	:	CA
Zip	:	93940-6532
Country	:	US
Telephone Number	:	831-333-2100
Fax Number	:	831-333-2105

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	11/07/2014

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