MEDICARE: DR. GARY STANDKE M.D.

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	G53286	CA

General Provider Information

NPI Number	:	1134193576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY STANDKE M.D.

Provider Business Mailing Address
First Line	:	7301 MED CTR DR
Second Line	:	#500
City	:	WEST HILLS
State	:	CA
Zip	:	91307-1904
Country	:	US
Telephone Number	:	818-226-1212
Fax Number	:	818-340-5861

Provider Business Practice Location Address
First Line	:	7301 MED CTR DR
Second Line	:	#500
City	:	WEST HILLS
State	:	CA
Zip	:	91307-1904
Country	:	US
Telephone Number	:	818-226-1212
Fax Number	:	818-340-5861

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	11/05/2012

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