1326384512

Everything you always wanted to know about IDENTITY MEDICAL GROUP, INC. DEUTSCH, M. GARY but were afraid to ask.

IDENTITY MEDICAL GROUP, INC. DEUTSCH, M. GARY

You can also download the this 1326384512 data report as csv | excel | json | xml
Organization Name Authorized Official Last Name Authorized Official Middle Name Authorized Official First Name
IDENTITY MEDICAL GROUP, INC. DEUTSCH, M. GARY
Gender:
none
Enumeration date:
2012-12-17
Last update date:
2014-07-29
Current as of:
2007-08-28
Is sole proprietor?:
Not Answered
Is organization subpart?:
No
In PECOS?:
No

Identifiers

identifier description issuer state active
HD754Z Medicare PIN none CA 1

Taxonomies

Taxonomy State License Number Primary?
207R00000X Internal Medicine CA none

Phone Numbers

Type Number
Mailing Address Telephone Number 8052567810
Practice Location Address Telephone Number 8052567810
Authorized Official Telephone Number 8055257131
Mailing Address Fax Number 8052567840
Practice Location Address Fax Number 8052567840

Addresses

Type Address City State Postal Country
Mailing Address 2125 KNOLL DR STE 104 VENTURA CA 93003 CA
Practice Location Address 2125 KNOLL DR STE 104 VENTURA CA 93003 CA

Other NPI Records that share a phone number

NPI Name Address State City
1962794578 MESCHER, MEGAN
Individual
2125 KNOLL DR CA VENTURA
1679568612 CHEN, JIAN
Individual
243 MARCH ST CA SANTA PAULA
1821083171 DEKKERS, ROBERT
Individual
243 MARCH ST CA SANTA PAULA
1932194289 DEUTSCH, GARY
Individual
243 MARCH ST CA SANTA PAULA