Provider Demographics
NPI:1538248117
Name:JANKOWSKI, GERALD JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:JOHN
Last Name:JANKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 SUNRISE AVE
Mailing Address - Street 2:SUITE 9B
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7005
Mailing Address - Country:US
Mailing Address - Phone:916-769-4085
Mailing Address - Fax:
Practice Address - Street 1:1000 SUNRISE AVE
Practice Address - Street 2:SUITE 9B
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7005
Practice Address - Country:US
Practice Address - Phone:916-769-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG11783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE08897OtherUPIN
CA021517OtherPIN
CA00G117830Medicare PIN
CA021517OtherPIN