Provider Demographics
NPI:1487800363
Name:GANSAR, GARY FISHEL (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:FISHEL
Last Name:GANSAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8480 HAYSTACK CT
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-7292
Mailing Address - Country:US
Mailing Address - Phone:303-915-4877
Mailing Address - Fax:303-652-1379
Practice Address - Street 1:8480 HAYSTACK CT
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-7292
Practice Address - Country:US
Practice Address - Phone:303-915-4877
Practice Address - Fax:303-652-1379
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33341208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice