MEDICARE: DR. GARY PAUL MCFEETERS 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	A-311896	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	:	1790813962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY PAUL MCFEETERS M.D.

Provider Business Mailing Address
First Line	:	7525 LINDA VISTA RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-5301
Country	:	US
Telephone Number	:	858-277-2361
Fax Number	:	858-569-1981

Provider Business Practice Location Address
First Line	:	7525 LINDA VISTA RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-5301
Country	:	US
Telephone Number	:	858-277-2361
Fax Number	:	858-569-1981

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/16/2010

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