Provider Demographics
NPI:1174569255
Name:MCCARTER, GARY S (DPM)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:MCCARTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1501 SUPERIOR AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3606
Mailing Address - Country:US
Mailing Address - Phone:949-631-4099
Mailing Address - Fax:949-650-7059
Practice Address - Street 1:1501 SUPERIOR AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3606
Practice Address - Country:US
Practice Address - Phone:949-631-4099
Practice Address - Fax:949-650-7059
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2663213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0805980001Medicare NSC
CAE2663Medicare ID - Type Unspecified
CAT11427Medicare UPIN