Provider Demographics
NPI:1427168301
Name:WOODALL, GARY NEAL (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:NEAL
Last Name:WOODALL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2970 5TH AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-5929
Mailing Address - Country:US
Mailing Address - Phone:619-260-3456
Mailing Address - Fax:619-260-3458
Practice Address - Street 1:2970 5TH AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5929
Practice Address - Country:US
Practice Address - Phone:619-260-3456
Practice Address - Fax:619-260-3458
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-05-05
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Provider Licenses
StateLicense IDTaxonomies
CAA54031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA54031MOtherPTAN