Provider Demographics
NPI:1386757995
Name:MESTER, GARY LEE (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEE
Last Name:MESTER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7018 COLTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210
Mailing Address - Country:US
Mailing Address - Phone:941-792-4357
Mailing Address - Fax:941-792-4341
Practice Address - Street 1:7018 COLTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210
Practice Address - Country:US
Practice Address - Phone:941-792-4357
Practice Address - Fax:941-792-4341
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3898111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
88784RMedicare ID - Type Unspecified
T85901Medicare UPIN