Provider Demographics
NPI:1184697401
Name:DANDY, GARY B (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:B
Last Name:DANDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1247
Mailing Address - Street 2:2570 NW EDENBOWER BLVD SUITE 100
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-0310
Mailing Address - Country:US
Mailing Address - Phone:541-957-1111
Mailing Address - Fax:541-957-5705
Practice Address - Street 1:2570 NW EDENBOWER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-6220
Practice Address - Country:US
Practice Address - Phone:541-957-1111
Practice Address - Fax:541-957-5705
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD16240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR059969Medicaid
ORJ406438OtherINDIVIDUAL PACSOURCE
ORJ406438OtherINDIVIDUAL PACSOURCE
OR059969Medicaid