Provider Demographics
NPI:1093720419
Name:VOORMAN, GARY SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:SCOTT
Last Name:VOORMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:G
Other - Middle Name:SCOTT
Other - Last Name:VOORMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:301 S MOORPARK RD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1008
Mailing Address - Country:US
Mailing Address - Phone:805-379-9646
Mailing Address - Fax:805-379-0611
Practice Address - Street 1:301 S MOORPARK RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1008
Practice Address - Country:US
Practice Address - Phone:805-379-9646
Practice Address - Fax:805-379-0611
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50563207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00957560OtherMEDICARE RAILROAD
CAG50563Medicare PIN
CAG50563CMedicare PIN
CAER946ZMedicare PIN
CAA51731Medicare UPIN