Provider Demographics
NPI:1790813962
Name:MCFEETERS, GARY PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:PAUL
Last Name:MCFEETERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7525 LINDA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-5301
Mailing Address - Country:US
Mailing Address - Phone:858-277-2361
Mailing Address - Fax:858-569-1981
Practice Address - Street 1:7525 LINDA VISTA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-5301
Practice Address - Country:US
Practice Address - Phone:858-277-2361
Practice Address - Fax:858-569-1981
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2010-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA-311896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0040150Medicaid
CAA-26634Medicare UPIN
CAGR0040150Medicaid