Wallace George Gosney, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

A19860 Issued in CA

Practice address

901 San Bernardino Rd
Ste 301
Upland, CA 91786-4912

Phone

(909) 946-6221

Fax

(909) 949-3802

NPI assigned

May 3, 2006

Last updated

Apr 9, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1428537600000",
    "number": "1417915778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 SAN BERNARDINO RD",
            "address_2": "STE 301",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864912",
            "telephone_number": "909-946-6221",
            "fax_number": "909-949-3802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 SAN BERNARDINO RD",
            "address_2": "STE 301",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864912",
            "telephone_number": "909-946-6221",
            "fax_number": "909-949-3802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOSNEY",
        "first_name": "WALLACE",
        "middle_name": "GEORGE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2015-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A19860",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "A19860",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A198600",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Good Hope Home Health Care Inc
• Good Shepherd Hospice, LLC
• Marieanne Goodwin, DC
• Lyric N Goosby, DOULA
• Robert B Gordon, MD
• Bjorn Lars Gothberg
• Lien Governanti, PHARM.D.
• Trisna Gozali, NP-C
• Gracious Heart Hospice & Palliative Care , Inc.
• Susie J. Graff, MFT

• Specialist in Upland, CA
• Providers in Upland, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.