Provider Demographics
NPI:1619961257
Name:NOVATT, GARY S (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:S
Last Name:NOVATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2285 CORPORATE CIR
Mailing Address - Street 2:STE 200
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7759
Mailing Address - Country:US
Mailing Address - Phone:702-360-2763
Mailing Address - Fax:949-783-2880
Practice Address - Street 1:2320 BATH ST
Practice Address - Street 2:STE 205
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105
Practice Address - Country:US
Practice Address - Phone:805-569-1164
Practice Address - Fax:805-569-1094
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2021-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG56325207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G563750Medicaid
D51086Medicare UPIN
CA00G563750Medicaid