Willard, Gary Marvin

Willard, Gary Marvin is an sole proprietor health care provider with primary practice located at 2588F El Camino Real Ste 127 , Carlsbad CA 92008-1201. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Undersea and Hyperbaric Medicine. Allopathic & Osteopathic Physicians / Undersea and Hyperbaric Medicine is his primary health care specialty. Willard, Gary Marvin can be contacted via phone (619) 564-4644.

Contact Information

Primary practice address
2588F El Camino Real Ste 127 Carlsbad CA 92008-1201
Phone: (619) 564-4644
Fax: (619) 810-2430
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X A34995 California
Allopathic & Osteopathic Physicians / Undersea and Hyperbaric Medicine 207PE0005X 254000 New York

Profile Details

NPI number 1588780373
LBN Legal business name Willard, Gary Marvin
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 22nd, 2007
Last updated Oct 18th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588780373 NPPES
California MEDICAID 03132152
California Other FE799Z

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