Provider Demographics
NPI:1124004387
Name:ALTER, GARY (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:ALTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:416 N BEDFORD DR
Mailing Address - Street 2:STE 400
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4322
Mailing Address - Country:US
Mailing Address - Phone:310-275-5566
Mailing Address - Fax:310-271-0521
Practice Address - Street 1:416 N BEDFORD DR
Practice Address - Street 2:STE 400
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4322
Practice Address - Country:US
Practice Address - Phone:310-275-5566
Practice Address - Fax:310-271-0521
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG27611208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG27611Medicare ID - Type Unspecified
CAA91064Medicare UPIN