Provider Demographics
NPI:1942383203
Name:SUGARMAN, GARY LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:LOUIS
Last Name:SUGARMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:LOUIS
Other - Last Name:SUGARMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:26991 CROWN VALLEY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6511
Mailing Address - Country:US
Mailing Address - Phone:949-582-5430
Mailing Address - Fax:493-489-5139
Practice Address - Street 1:26991 CROWN VALLEY PKWY STE 100
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6511
Practice Address - Country:US
Practice Address - Phone:949-582-5430
Practice Address - Fax:949-348-9513
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81230207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG81230Medicare ID - Type Unspecified
CAF72863Medicare UPIN