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General NPI Number Information
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NPI Number | 1427246453
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Entity Type | Organization
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Legal Business Name | GARY J PROFFETT, MD, APC
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 1901 SOLAR DR
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City | OXNARD
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State | CA
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Zip | 93036-2641
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Country | US
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Telephone | 805-658-2552
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Fax |
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Provider Business Mailing Address
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Address Line | 46 CALLE DEL NORTE
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-5210
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Country | US
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Telephone | 805-658-2552
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY PROFFETT
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Credential | MD
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Telephone | 805-658-2552
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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