MEDICARE: DR. BERT N. GILLING 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	207L00000X	Anesthesiology Physician	G27750	CA
2	207L00000X	Anesthesiology Physician	MD-2773	HI

General Provider Information

NPI Number	:	1568552875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERT N. GILLING M.D.

Provider Business Mailing Address
First Line	:	501 WINCHESTER CT
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-1814
Country	:	US
Telephone Number	:	925-947-6927
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 WINCHESTER CT
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-1814
Country	:	US
Telephone Number	:	925-947-6927
Fax Number	:

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

Provider Enumeration Date	:	10/15/2006
Last Update Date	:	07/08/2007

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