Provider Demographics
NPI:1326283821
Name:MCGOVERN, DERMOT P (MD, PHD, MRCP)
Entity Type:Individual
Prefix:DR
First Name:DERMOT
Middle Name:P
Last Name:MCGOVERN
Suffix:
Gender:M
Credentials:MD, PHD, MRCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 512717
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0717
Mailing Address - Country:US
Mailing Address - Phone:310-423-4100
Mailing Address - Fax:310-967-1800
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-4100
Practice Address - Fax:310-967-1800
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASFP000014207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology