Provider Demographics
NPI:1942264015
Name:FALKOFF, GARY E I (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:E
Last Name:FALKOFF
Suffix:I
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93062-0190
Mailing Address - Country:US
Mailing Address - Phone:805-577-2021
Mailing Address - Fax:805-577-2018
Practice Address - Street 1:627 BRUNKEN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-5002
Practice Address - Country:US
Practice Address - Phone:831-796-3740
Practice Address - Fax:831-751-6393
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG5975702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G597570Medicaid
00G597570Medicare PIN
CAC04346Medicare UPIN
CA00G597570Medicaid
AX440WMedicare PIN
AX440XMedicare PIN
AX440YMedicare PIN
AX440ZMedicare PIN
AX440VMedicare PIN