Provider Demographics
NPI:1629084595
Name:ZEGER, GARY D (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:D
Last Name:ZEGER
Suffix:
Gender:M
Credentials:MD
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 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-2582
Mailing Address - Fax:323-442-2588
Practice Address - Street 1:1450 SAN PABLO STREET
Practice Address - Street 2:ROOM 2422
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-2582
Practice Address - Fax:323-442-2588
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50514207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952325565OtherGROUP NPI
CA220024066OtherMEDICARE RAILROAD
CA00G505140Medicaid
CA00G505140OtherBLUE SHIELD
CAWA50514CMedicare PIN
CAHW7801BMedicare PIN
CAHW7801AMedicare PIN
CAWA50514BMedicare PIN
CA1952325565OtherGROUP NPI
CAWA50514AMedicare PIN