Provider Demographics
NPI:1184770638
Name:KATLER, ERNEST IVAN (MD)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:IVAN
Last Name:KATLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2101 VALE ROAD
Mailing Address - Street 2:SUITE101
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806
Mailing Address - Country:US
Mailing Address - Phone:510-620-0496
Mailing Address - Fax:510-233-0538
Practice Address - Street 1:2101 VALE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806
Practice Address - Country:US
Practice Address - Phone:510-620-0496
Practice Address - Fax:510-233-0538
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2015-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA24404207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A244040Medicaid
CA00A244040Medicare PIN
CAA23966Medicare UPIN