Provider Demographics
NPI:1366572471
Name:GEMBERLING, RONALD MARK (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MARK
Last Name:GEMBERLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3803 S BASCOM AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-7317
Mailing Address - Country:US
Mailing Address - Phone:408-559-8658
Mailing Address - Fax:408-559-8678
Practice Address - Street 1:3803 S BASCOM AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-7317
Practice Address - Country:US
Practice Address - Phone:408-559-8658
Practice Address - Fax:408-559-8678
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2008-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA260402086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A260401Medicare PIN
CAA24686Medicare UPIN