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NPI Code Detail

MEDICARE: RUSSELL M GILBERTSON MD A PROFESSIONAL CORPORATION

MEDICARE: RUSSELL M GILBERTSON MD A PROFESSIONAL CORPORATION
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
1207L00000XAnesthesiology PhysicianG476910CA

Other Identifiers

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

General Provider Information

NPI Number : 1942377189
Entity Type Code : Organization
Provider Name (Legal Business Name) : RUSSELL M GILBERTSON MD A PROFESSIONAL CORPORATION
Provider Business Mailing Address
First Line : PO BOX 3129
Second Line :
City : TORRANCE
State : CA
Zip : 90510-3129
Country : US
Telephone Number : 310-792-3914
Fax Number :
Provider Business Practice Location Address
First Line : 1246 W 155TH ST
Second Line :
City : GARDENA
State : CA
Zip : 90247-4011
Country : US
Telephone Number : 562-407-2080
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : RUSSELL GILBERTSON
Credential : MD
Telephone Number : 562-407-2080
Provider Enumeration Date : 11/30/2006
Last Update Date : 10/29/2021

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