Provider Demographics
NPI:1407949233
Name:GAMMER, STEVEN E (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
Last Name:GAMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 PACIFIC COAST HWY STE 212
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6643
Mailing Address - Country:US
Mailing Address - Phone:562-431-8554
Mailing Address - Fax:562-596-7764
Practice Address - Street 1:500 PACIFIC COAST HWY STE 212
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-6643
Practice Address - Country:US
Practice Address - Phone:562-431-8554
Practice Address - Fax:562-596-7764
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26248207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G262480Medicaid
CAA42950Medicare UPIN
CA00G262480Medicaid