Provider Demographics
NPI:1184745580
Name:PAINTER, GARY LEWIS (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LEWIS
Last Name:PAINTER
Suffix:
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 1:11354 MOUNTAIN VIEW AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3855
Mailing Address - Country:US
Mailing Address - Phone:909-799-7171
Mailing Address - Fax:909-799-5959
Practice Address - Street 1:11354 MOUNTAIN VIEW AVE STE A
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3855
Practice Address - Country:US
Practice Address - Phone:909-799-7171
Practice Address - Fax:909-799-5959
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45370207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50002Medicare UPIN
CA00G453700Medicare ID - Type Unspecified