Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | C37116 | CA |
NPI | 1023127974 |
---|---|
Provider Name | Dr. Michael William Gaynon |
First Address | Palo Alto, CA 94303-3318 |
Second Address | Stanford, CA 94305-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 13/04/2018 |