Provider Demographics
NPI:1134193576
Name:STANDKE, GARY (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:STANDKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7301 MED CTR DR
Mailing Address - Street 2:#500
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1904
Mailing Address - Country:US
Mailing Address - Phone:818-226-1212
Mailing Address - Fax:818-340-5861
Practice Address - Street 1:7301 MED CTR DR
Practice Address - Street 2:#500
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1904
Practice Address - Country:US
Practice Address - Phone:818-226-1212
Practice Address - Fax:818-340-5861
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG53286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52490Medicare UPIN