Provider Demographics
NPI:1427472745
Name:GASTRO CONSULTANTS OF SACRAMENTO, INC.
Entity type:Organization
Organization Name:GASTRO CONSULTANTS OF SACRAMENTO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:SAM
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-751-7165
Mailing Address - Street 1:262 BURGENLAND AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-0343
Mailing Address - Country:US
Mailing Address - Phone:209-751-7165
Mailing Address - Fax:209-579-2354
Practice Address - Street 1:1014 N MARKET BLVD
Practice Address - Street 2:SUITE 45
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1986
Practice Address - Country:US
Practice Address - Phone:209-751-7165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66389207RG0100X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty