Provider Demographics
NPI:1861567307
Name:DHILLON, GURTEJ S (MD)
Entity type:Individual
Prefix:
First Name:GURTEJ
Middle Name:S
Last Name:DHILLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1912 S COURT ST
Mailing Address - Street 2:STE A
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-5426
Mailing Address - Country:US
Mailing Address - Phone:559-733-7090
Mailing Address - Fax:559-733-7175
Practice Address - Street 1:1912 SOUTH COURT
Practice Address - Street 2:STE A
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277
Practice Address - Country:US
Practice Address - Phone:559-733-7090
Practice Address - Fax:559-733-7175
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2012-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA50100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A501000Medicaid
F82265Medicare UPIN
CA00A501000Medicaid