Healthcare Provider Details

I. General information

NPI: 1326105313
Provider Name (Legal Business Name): GARY PACE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 UNIVERSITY ST
HEALDSBURG CA
95448
US

IV. Provider business mailing address

100 WEST THIRD ST
CLOVERDALE CA
95425-0100
US

V. Phone/Fax

Practice location:
  • Phone: 707-433-5494
  • Fax: 707-431-8649
Mailing address:
  • Phone: 707-894-4229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA52538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: