MEDICARE: DR. GARY NEAL FURNESS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A42216	CA

General Provider Information

NPI Number	:	1144281635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY NEAL FURNESS MD

Provider Business Mailing Address
First Line	:	2455 SUMMERFIELD RD
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-7815
Country	:	US
Telephone Number	:	707-523-2666
Fax Number	:	707-523-3399

Provider Business Practice Location Address
First Line	:	2455 SUMMERFIELD RD
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-7815
Country	:	US
Telephone Number	:	707-523-2666
Fax Number	:	707-523-3399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2006
Last Update Date	:	04/24/2008

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