Provider Demographics
NPI:1154392892
Name:CRITSER, GARY (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:CRITSER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 E HERNDON AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2993
Mailing Address - Country:US
Mailing Address - Phone:559-226-7107
Mailing Address - Fax:559-226-1432
Practice Address - Street 1:540 E HERNDON AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2993
Practice Address - Country:US
Practice Address - Phone:559-226-7107
Practice Address - Fax:559-226-1432
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A57980OtherBLUE SHIELD
CA020A57980OtherBLUE CROSS
CA020A57980OtherBLUE CROSS
CA020A57982Medicare Oscar/Certification