Provider Demographics
NPI:1790811321
Name:WYNBRANDT, GARY (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:WYNBRANDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:899 SANTA CRUZ AVE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025
Mailing Address - Country:US
Mailing Address - Phone:650-327-6173
Mailing Address - Fax:650-325-1746
Practice Address - Street 1:899 SANTA CRUZ AVE
Practice Address - Street 2:SUITE #200
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025
Practice Address - Country:US
Practice Address - Phone:650-327-6173
Practice Address - Fax:650-325-1746
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG333602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZP4315ZMedicare ID - Type Unspecified