Gosney, Wallace George

Gosney, Wallace George is an individual health care provider with primary practice located at 901 San Bernardino Rd Ste 301, Upland CA 91786-4912. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Vascular Surgery. Other Service Providers / Specialist is his primary health care specialty. Gosney, Wallace George can be contacted via phone (909) 946-6221.

Contact Information

Primary practice address
901 San Bernardino Rd Ste 301 Upland CA 91786-4912
Phone: (909) 946-6221
Fax: (909) 949-3802
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X A19860 California
Allopathic & Osteopathic Physicians / Vascular Surgery 2086S0129X A19860 California

Profile Details

NPI number 1417915778
LBN Legal business name Gosney, Wallace George
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 3rd, 2006
Last updated Apr 9th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417915778 NPPES
California MEDICAID 00A198600

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