Provider Demographics
NPI:1063585495
Name:KORFF, GARY P (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:P
Last Name:KORFF
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 1:2562 STATE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1663
Mailing Address - Country:US
Mailing Address - Phone:760-729-7186
Mailing Address - Fax:760-729-2753
Practice Address - Street 1:2562 STATE ST STE D
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1663
Practice Address - Country:US
Practice Address - Phone:760-729-7186
Practice Address - Fax:760-729-2753
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G695530Medicaid
CA00G695530Medicaid
CAWG69553EMedicare PIN
CA00G695530Medicaid