Provider Demographics
NPI:1861447302
Name:ANNUNZIATA, GARY MORTON (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MORTON
Last Name:ANNUNZIATA
Suffix:
Gender:M
Credentials:DO
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:35900 BOB HOPE DR
Mailing Address - Street 2:STE 275
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1766
Mailing Address - Country:US
Mailing Address - Phone:760-321-2500
Mailing Address - Fax:760-321-5720
Practice Address - Street 1:35900 BOB HOPE DR
Practice Address - Street 2:STE 275
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1766
Practice Address - Country:US
Practice Address - Phone:760-321-2500
Practice Address - Fax:760-321-5720
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA020A66500207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A66501Medicare PIN