Individual
GARY MARVIN WILLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2588F EL CAMINO REAL STE 127, CARLSBAD, CA 92008-1201
(619) 564-4644
(619) 810-2430
Mailing address
2588F EL CAMINO REAL STE 127, CARLSBAD, CA 92008-1201
(619) 564-4644
(619) 810-2430
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A34995
CA
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
Primary
254000
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03132152
—
CA
01
—
FE799Z
MEDICARE ID
CA
Enumeration date
03/22/2007
Last updated
10/18/2019
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