Healthcare Provider Details

I. General information

NPI: 1255092052
Provider Name (Legal Business Name): DAVID ANGERT, MD, PHD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 01/04/2022
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 PROSPECT AVE
LONG BEACH CA
90803-1620
US

IV. Provider business mailing address

243 PROSPECT AVE
LONG BEACH CA
90803-1620
US

V. Phone/Fax

Practice location:
  • Phone: 310-923-6287
  • Fax:
Mailing address:
  • Phone: 310-923-6287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID W ANGERT
Title or Position: OWNER
Credential: MD PHD
Phone: 310-923-6287