Healthcare Provider Details

I. General information

NPI: 1750481677
Provider Name (Legal Business Name): GARY PETER SEGAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST VA MED CENTER; MEDICAL HEALTHCARE GROUP
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

5901 E 7TH ST MEDICAL SERVICE
LONG BEACH CA
90822-5201
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-5484
  • Fax:
Mailing address:
  • Phone: 714-791-7502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG32778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: