Provider Demographics
NPI:1659342905
Name:MALET, GARY F (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:F
Last Name:MALET
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1144 NORMAN DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-5925
Mailing Address - Country:US
Mailing Address - Phone:209-823-1152
Mailing Address - Fax:209-948-2831
Practice Address - Street 1:1508 WEST LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95205-3340
Practice Address - Country:US
Practice Address - Phone:209-948-2886
Practice Address - Fax:209-948-2831
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5125207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25352ZOtherGROUP PTAN
CAZZZ25352ZOtherGROUP PTAN
CAE08880Medicare UPIN