Provider Demographics
NPI:1265426183
Name:SCHENK, ALAN R (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:R
Last Name:SCHENK
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 1:24331 EL TORO RD
Mailing Address - Street 2:STE. 380
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-2752
Mailing Address - Country:US
Mailing Address - Phone:949-583-0222
Mailing Address - Fax:949-583-0252
Practice Address - Street 1:24331 EL TORO RD
Practice Address - Street 2:STE. 380
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2752
Practice Address - Country:US
Practice Address - Phone:949-583-0222
Practice Address - Fax:949-583-0252
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2012-09-18
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CAG46010207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330124860OtherMOST OF THE CARRIERS
CA00G460101OtherBLUE SHIELD OF CALIFORNIA
CA330124860OtherTRICARE
CAA50264Medicare UPIN
CAG46010Medicare ID - Type UnspecifiedMEDICARE