Provider Demographics
NPI:1700857422
Name:WILLEN, GARY F (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:F
Last Name:WILLEN
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 1:961 MICA DR
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89705-7269
Mailing Address - Country:US
Mailing Address - Phone:775-267-6700
Mailing Address - Fax:775-267-6609
Practice Address - Street 1:961 MICA DR
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89705-7269
Practice Address - Country:US
Practice Address - Phone:530-544-8333
Practice Address - Fax:530-542-1455
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53304207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700857422Medicaid
CA00G533040Medicare PIN
A52489Medicare UPIN
CA1700857422Medicaid