Provider Demographics
NPI:1932173085
Name:ALZATE, GREGG D (MD)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:D
Last Name:ALZATE
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 23540
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-3540
Mailing Address - Country:US
Mailing Address - Phone:858-565-0950
Mailing Address - Fax:858-244-1100
Practice Address - Street 1:8745 AERO DRIVE
Practice Address - Street 2:STE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1774
Practice Address - Country:US
Practice Address - Phone:858-565-0950
Practice Address - Fax:858-244-1100
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG420152085R0202X, 2085R0204X, 2085B0100X, 2085U0001X, 2085N0700X, 2085N0904X, 2085R0203X, 208VP0000X, 208VP0014X, 2085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083810Medicaid
CAGR0083813Medicaid
CAGR0083814Medicaid
CAGR0083811Medicaid
CAGR0083812Medicaid
CAGR0083817Medicaid
CA00G420150Medicaid
CAZZZ75341ZMedicaid
CAGR0083815Medicaid
CAW529AMedicare PIN
CAGR0083813Medicaid
CAGR0083811Medicaid
CAGR0083815Medicaid
CAGR0083817Medicaid
CATD009BMedicare PIN
A89744Medicare UPIN
CA00G420150Medicaid
CATD009Medicare PIN