Provider Demographics
NPI:1851438329
Name:BOGART, GARY N (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:N
Last Name:BOGART
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Gender:M
Credentials:DO
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Mailing Address - Street 1:9350 CAMPUS POINT DRIVE LLB
Mailing Address - Street 2:MAIL CODE - 0968
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0968
Mailing Address - Country:US
Mailing Address - Phone:858-657-8600
Mailing Address - Fax:858-657-8587
Practice Address - Street 1:9350 CAMPUS POINT DRIVE LLB
Practice Address - Street 2:MAIL CODE - 0968
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0968
Practice Address - Country:US
Practice Address - Phone:858-657-8600
Practice Address - Fax:858-657-8587
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CA20A6243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F19908Medicare UPIN