Provider Demographics
NPI:1932181724
Name:ARENDS, GARY L JR (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:ARENDS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 VALLEY CHILDRENS PL # FE10
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8761
Mailing Address - Country:US
Mailing Address - Phone:559-353-5941
Mailing Address - Fax:559-353-5945
Practice Address - Street 1:9300 VALLEY CHILDRENS PL # FE10
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93636-8761
Practice Address - Country:US
Practice Address - Phone:559-353-5941
Practice Address - Fax:559-353-5945
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8430207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0020A84300Medicaid
CA20A8430OtherOSTEOPATHIS PHYSICIAN &
CA20A8430OtherOSTEOPATHIS PHYSICIAN &
CA105151Medicare UPIN
CA20A8430OtherOSTEOPATHIS PHYSICIAN &
CAW20A8430AMedicare ID - Type Unspecified
I05151Medicare UPIN