Individual
GARY TYLER BUCKHOLZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4311 THIRD AVE, SAN DIEGO, CA 92103-1407
(619) 688-1600
(619) 278-6163
Mailing address
PO BOX 232410, SAN DIEGO, CA 92193-2410
(858) 249-6749
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
A82836
CA
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
A82836
CA
Other
Enumeration date
11/01/2006
Last updated
08/16/2017
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