Healthcare Provider Details

I. General information

NPI: 1427246453
Provider Name (Legal Business Name): GARY J PROFFETT, MD, APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 06/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SOLAR DR
OXNARD CA
93036-2641
US

IV. Provider business mailing address

46 CALLE DEL NORTE
RANCHO MIRAGE CA
92270-5210
US

V. Phone/Fax

Practice location:
  • Phone: 805-658-2552
  • Fax:
Mailing address:
  • Phone: 805-658-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GARY PROFFETT
Title or Position: PRESIDENT
Credential: MD
Phone: 805-658-2552