Provider Demographics
NPI:1295185254
Name:PAGLER, ELIZABETH SUWARTONO (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUWARTONO
Last Name:PAGLER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:12370 HESPERIA RD STE 13
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5808
Mailing Address - Country:US
Mailing Address - Phone:760-245-4747
Mailing Address - Fax:760-245-4868
Practice Address - Street 1:12408 HESPERIA RD STE 21
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7718
Practice Address - Country:US
Practice Address - Phone:760-553-7000
Practice Address - Fax:760-269-1275
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2020-08-10
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Provider Licenses
StateLicense IDTaxonomies
MI4301110149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine