| Gary M Van Deventer Md Inc | |
|
504 W Pueblo St Ste 201 Santa Barbara CA 93105-6211 | |
| (805) 563-0024 | |
| Not Available |
| Full Name | Gary M Van Deventer Md Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 504 W Pueblo St Ste 201, Santa Barbara, California |
| Authorized Official Name and Position | Gary Vandeventer (OWNER) |
| Authorized Official Contact | 8059633757 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gary M Van Deventer Md Inc Po Box 50706 Santa Barbara CA 93150-0706 Ph: () - | Gary M Van Deventer Md Inc 504 W Pueblo St Ste 201 Santa Barbara CA 93105-6211 Ph: (805) 563-0024 |
| NPI Number | 1861045106 |
|---|---|
| Provider Enumeration Date | 07/16/2019 |
| Last Update Date | 07/16/2019 |
| Medicare PECOS PAC ID | 4688001563 |
|---|---|
| Medicare Enrollment ID | O20200305002716 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861045106 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | Gary M Vandeventer |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1285628933 PECOS PAC ID: 8628046083 Enrollment ID: I20040923000799 |
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