Provider Demographics
NPI:1043458698
Name:STOCK, GARY (CRNA)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:STOCK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4150 V STREET, PSSB SUITE 1200
Mailing Address - Street 2:UCDMC DEPT. OF ANESTHESIOLOGY & PAIN MEDICINE
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1460
Mailing Address - Country:US
Mailing Address - Phone:916-734-5042
Mailing Address - Fax:916-734-2975
Practice Address - Street 1:4150 V STREET, PSSB SUITE 1200
Practice Address - Street 2:UCDMC DEPT. OF ANESTHESIOLOGY & PAIN MEDICINE
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-5042
Practice Address - Fax:916-734-2975
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA617189 RN367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA617189OtherRN LICENSE