Basic Information
| Provider Information | |||||||||
| NPI: | 1073552808 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GANDY | ||||||||
| FirstName: | DONALD | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 498 RIVER PARK DR | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960035367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302426602 | ||||||||
| FaxNumber: | 5302431309 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 BUTTE ST | ||||||||
| Address2: | |||||||||
| City: | REDDING | ||||||||
| State: | CA | ||||||||
| PostalCode: | 960010852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302430498 | ||||||||
| FaxNumber: | 5302431309 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | F32559 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00AX59450 | 05 | CA | MEDICAID | F32559 | 01 | TX | UPIN # | OTHER |