Individual
GARY M VAN DEVENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
221 W PUEBLO ST, SUITE B, SANTA BARBARA, CA 93105-6814
(805) 563-0024
(805) 563-1454
Mailing address
PO BOX 50706, SANTA BARBARA, CA 93150-0706
(805) 563-0024
(805) 563-1454
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
C39157
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C391570
—
CA
01
—
100004009
RAILROAD MEDICARE
CA
Enumeration date
09/08/2005
Last updated
03/24/2009
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