Provider Demographics
NPI:1528365962
Name:COLNER, GARY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
Last Name:COLNER
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 1:4913 COLUSA DRIVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056
Mailing Address - Country:US
Mailing Address - Phone:760-806-5390
Mailing Address - Fax:
Practice Address - Street 1:4913 COLUSA DR
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5465
Practice Address - Country:US
Practice Address - Phone:760-806-5390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38411208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice