Provider Demographics
NPI:1265561047
Name:AYZENGART, ALEXANDER L (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:L
Last Name:AYZENGART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1155 MILL ST # M14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-5496
Practice Address - Street 1:1500 E 2ND ST STE 300
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1198
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3900
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV21858208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV21858OtherNV MD LICENSE
NV15489434OtherCAQH