Provider Demographics
NPI:1295956175
Name:PERRAULT, GARY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LYNN
Last Name:PERRAULT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:414 NORTH CAMDEN DR.
Mailing Address - Street 2:SUITE 725
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210
Mailing Address - Country:US
Mailing Address - Phone:310-281-2121
Mailing Address - Fax:310-281-2150
Practice Address - Street 1:414 NORTH CAMDEN DR.
Practice Address - Street 2:SUITE 725
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210
Practice Address - Country:US
Practice Address - Phone:310-281-2121
Practice Address - Fax:310-281-2150
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2008-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG79686208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery