Healthcare Provider Details

I. General information

NPI: 1265683767
Provider Name (Legal Business Name): BARRY GORDON GWARTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8592 LOOKOUT MOUNTAIN AVE
LOS ANGELES CA
90046-1814
US

IV. Provider business mailing address

8592 LOOKOUT MOUNTAIN AVE
LOS ANGELES CA
90046-1814
US

V. Phone/Fax

Practice location:
  • Phone: 323-655-4701
  • Fax: 310-641-8685
Mailing address:
  • Phone: 323-655-4701
  • Fax: 310-641-8685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG12309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: