Provider Demographics
NPI:1407884281
Name:FLETCHER, GARY ALLAN (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALLAN
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620-H EAST BARNETT ROAD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8383
Mailing Address - Country:US
Mailing Address - Phone:541-773-7273
Mailing Address - Fax:541-773-2027
Practice Address - Street 1:2620-H EAST BARNETT ROAD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8383
Practice Address - Country:US
Practice Address - Phone:541-773-7273
Practice Address - Fax:541-773-2027
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08397207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR261214Medicaid
00WCGCVFMedicare ID - Type Unspecified
OR261214Medicaid