Provider Demographics
NPI:1932194289
Name:DEUTSCH, GARY M (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:M
Last Name:DEUTSCH
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 1:243 MARCH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2511
Mailing Address - Country:US
Mailing Address - Phone:805-525-7131
Mailing Address - Fax:805-525-0041
Practice Address - Street 1:243 MARCH ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2511
Practice Address - Country:US
Practice Address - Phone:805-525-7131
Practice Address - Fax:805-525-0041
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38310207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G383100OtherBLUE SHIELD
CAHD754ZOtherMEDICARE PROVIDER ID
CA00G383100Medicaid
CA00G383100Medicaid
CA00G383100OtherBLUE SHIELD