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General NPI Number Information
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NPI Number | 1790855336
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Entity Type | Organization
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Legal Business Name | D. GARETH WOOTTON, M.D., INC.
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 11/25/2008
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Provider Practice Location Address
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Address Line | 1301 20TH ST STE 470
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City | SANTA MONICA
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State | CA
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Zip | 90404-2090
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Country | US
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Telephone | 310-315-0222
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Fax | 310-828-8852
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Provider Business Mailing Address
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Address Line | 1301 20TH ST STE 470
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City | SANTA MONICA
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State | CA
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Zip | 90404-2090
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Country | US
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Telephone | 310-315-0222
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Fax | 310-828-8852
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. D. GARETH WOOTTON
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Credential | M.D.
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Telephone | 310-315-0222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | G10008
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License Number State | CA
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