MEDICARE: GARY DUCKWILER MD

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	2085R0202X	Diagnostic Radiology Physician	G052580	CA
2	2085R0204X	Vascular & Interventional Radiology Physician	G052580	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538111216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY DUCKWILER MD

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 UCLA MEDICAL PLZ STE 100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-7000
Country	:	US
Telephone Number	:	310-481-7545
Fax Number	:	310-794-9035

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	06/09/2022

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Directions to “ GARY DUCKWILER MD” Practice Location

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