Provider Demographics
NPI:1548266018
Name:GEBHARD, KARL J (MD)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:J
Last Name:GEBHARD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:26922 OSO PKWY
Mailing Address - Street 2:SUITE 380
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5800
Mailing Address - Country:US
Mailing Address - Phone:949-305-0110
Mailing Address - Fax:949-305-0101
Practice Address - Street 1:26922 OSO PKWY
Practice Address - Street 2:SUITE 380
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5800
Practice Address - Country:US
Practice Address - Phone:949-305-0110
Practice Address - Fax:949-305-0101
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2016-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG80567207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB224503Medicare PIN