Provider Demographics
NPI:1235108044
Name:GOZAN, NEIL HERBERT (MD)
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:HERBERT
Last Name:GOZAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1054 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2628
Mailing Address - Country:US
Mailing Address - Phone:510-898-1123
Mailing Address - Fax:510-898-1120
Practice Address - Street 1:1054 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2628
Practice Address - Country:US
Practice Address - Phone:510-898-1123
Practice Address - Fax:510-898-1120
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG24857207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G248570Medicaid
CA00G248570Medicare ID - Type Unspecified
CA00G248570Medicaid