Healthcare Provider Details

I. General information

NPI: 1598793119
Provider Name (Legal Business Name): KURT RAYMOND NEUBAUER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N FIFTH AVE 101
ARCADIA CA
91006-3711
US

IV. Provider business mailing address

225 S LAKE AVE 535
PASADENA CA
91101-3005
US

V. Phone/Fax

Practice location:
  • Phone: 626-471-9901
  • Fax: 626-471-9020
Mailing address:
  • Phone: 626-795-6596
  • Fax: 626-795-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG52011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: