Provider Demographics
NPI:1356314868
Name:LIZER, GREGORY (MD)
Entity Type:Individual
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First Name:GREGORY
Middle Name:
Last Name:LIZER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:133 N ALTADENA DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-7325
Mailing Address - Country:US
Mailing Address - Phone:626-397-8335
Mailing Address - Fax:626-397-8350
Practice Address - Street 1:1346 FOOTHILL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2122
Practice Address - Country:US
Practice Address - Phone:818-790-5583
Practice Address - Fax:818-790-9517
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2014-01-22
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Provider Licenses
StateLicense IDTaxonomies
CAA60165208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG57004Medicare UPIN