Provider Demographics
NPI:1154344695
Name:MATSON, GARY L JR (DO)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:L
Last Name:MATSON
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:4501 MISSION BAY DR
Mailing Address - Street 2:SUITE 3E
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-4923
Mailing Address - Country:US
Mailing Address - Phone:858-270-4343
Mailing Address - Fax:858-272-1731
Practice Address - Street 1:4501 MISSION BAY DR
Practice Address - Street 2:SUITE 3E
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4923
Practice Address - Country:US
Practice Address - Phone:858-270-4343
Practice Address - Fax:858-272-1731
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CA20A6263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF75512Medicare UPIN