Provider Demographics
NPI:1730245416
Name:GADWOOD, GARY J (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:GADWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2150 APPIAN WAY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2583
Mailing Address - Country:US
Mailing Address - Phone:510-724-0481
Mailing Address - Fax:510-724-3082
Practice Address - Street 1:2150 APPIAN WAY
Practice Address - Street 2:SUITE 206
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2583
Practice Address - Country:US
Practice Address - Phone:510-724-0481
Practice Address - Fax:510-724-3082
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00G236200208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42016Medicare UPIN