Provider Demographics
NPI:1043271620
Name:GEFT, IVOR (MD)
Entity Type:Individual
Prefix:
First Name:IVOR
Middle Name:
Last Name:GEFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 N L A CIENEGA BL VD
Mailing Address - Street 2:#103
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211
Mailing Address - Country:US
Mailing Address - Phone:310-623-1146
Mailing Address - Fax:310-623-1142
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:#445E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-659-7537
Practice Address - Fax:310-623-1142
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37160174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84977Medicare UPIN