Provider Demographics
NPI:1942204375
Name:HARKINS, GARY L (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:HARKINS
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 1:1941 JOHNSON AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4169
Mailing Address - Country:US
Mailing Address - Phone:805-543-5577
Mailing Address - Fax:805-595-3231
Practice Address - Street 1:1941 JOHNSON AVE
Practice Address - Street 2:STE 201
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4169
Practice Address - Country:US
Practice Address - Phone:805-543-5577
Practice Address - Fax:805-595-3231
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25721207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG25721OtherMEDICAL LICENSE #
CA00G257210Medicaid
CJ5643OtherRR MEDICARE PIN
CAGR0091140Medicaid
2257346OtherFIRST HEALTH PIN
CA1018OtherCMSP GRP PIN
CA00G257210Medicaid
W15485Medicare PIN