Provider Demographics
NPI:1184763633
Name:FINSTAD, GARY ARLYN (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:ARLYN
Last Name:FINSTAD
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 1:43 FRONTIER TRAIL
Mailing Address - Street 2:P.O. BOX 940
Mailing Address - City:KERNVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93238-0000
Mailing Address - Country:US
Mailing Address - Phone:760-417-9641
Mailing Address - Fax:760-379-7658
Practice Address - Street 1:6425 LYNCH CANYON DR
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:CA
Practice Address - Zip Code:93240-9726
Practice Address - Country:US
Practice Address - Phone:760-379-8630
Practice Address - Fax:760-379-7658
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43717207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0022310Medicaid
CAG43717OtherMEDICAL LICENSE
CAGR0022310Medicaid
A49441Medicare UPIN
CAGR0022310Medicaid