Individual
DR. BRUCE DAVID GAYNOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4720 HOEN AVE, SANTA ROSA, CA 95405-7867
(707) 527-8222
(707) 527-5318
Mailing address
4720 HOEN AVE, SANTA ROSA, CA 95405-7867
(707) 527-8222
(707) 527-5318
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G845350
CA
207W00000X
Ophthalmology Physician
G845350
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G845350
—
CA
01
—
180041368
MEDICARE RAILROAD
CA
Enumeration date
07/05/2006
Last updated
06/16/2008
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