Provider Demographics
NPI:1033405584
Name:ANGERT, DAVID W (MD/PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:ANGERT
Suffix:
Gender:M
Credentials:MD/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-1620
Mailing Address - Country:US
Mailing Address - Phone:310-923-6287
Mailing Address - Fax:
Practice Address - Street 1:243 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-1620
Practice Address - Country:US
Practice Address - Phone:310-923-6287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAT32HL1162731744R1102X
PAMT198953207R00000X
CA115994207ZP0102X
CAA131722208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No1744R1102XOther Service ProvidersSpecialistResearch Study
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA19113GAPMedicaid