Provider Demographics
NPI:1053480327
Name:ALTMAN, JOHN HYDE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HYDE
Last Name:ALTMAN
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 1:10850 WILSHIRE BLVD
Mailing Address - Street 2:1175
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4327
Mailing Address - Country:US
Mailing Address - Phone:310-470-6588
Mailing Address - Fax:310-446-1604
Practice Address - Street 1:10850 WILSHIRE BLVD
Practice Address - Street 2:1175
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4327
Practice Address - Country:US
Practice Address - Phone:310-470-6588
Practice Address - Fax:310-446-1604
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG443712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG44371Medicare ID - Type Unspecified