MEDICARE: GERARD BAZILE MD A PROFESSIONAL MEDICAL 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
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician

General Provider Information

NPI Number	:	1952316812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERARD BAZILE MD A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 1770
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91944-1770
Country	:	US
Telephone Number	:	619-464-1165
Fax Number	:	619-567-1011

Provider Business Practice Location Address
First Line	:	6699 ALVARADO RD
Second Line	:	SUITE 2306
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5238
Country	:	US
Telephone Number	:	619-286-0100
Fax Number	:	619-286-0600

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GERARD IRVELT BAZILE
Credential	:	MD
Telephone Number	:	619-286-0100

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	07/11/2014

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Directions to “GERARD BAZILE MD A PROFESSIONAL MEDICAL CORPORATION ” Practice Location

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