Provider Demographics
NPI:1548281322
Name:GISH, ROBERT GARETH (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:GARETH
Last Name:GISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6022 LA JOLLA MESA DR
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7814
Mailing Address - Country:US
Mailing Address - Phone:858-229-9865
Mailing Address - Fax:
Practice Address - Street 1:1580 CREEKSIDE DR STE 220
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3888
Practice Address - Country:US
Practice Address - Phone:916-986-4444
Practice Address - Fax:916-983-8563
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG45632207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G456320Medicaid
CA00G456320Medicaid