Provider Demographics
NPI:1003837766
Name:GWYNN, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:GWYNN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:22691 PLAZA DRIVE
Mailing Address - Street 2:SUITE #250
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-364-0225
Mailing Address - Fax:949-364-9014
Practice Address - Street 1:22691 PLAZA DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-364-0225
Practice Address - Fax:949-364-9014
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2020-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG86237207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G862370OtherBLUE SHIELD
WG86237EMedicare ID - Type Unspecified
CA00G862370OtherBLUE SHIELD