=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972686954
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREGORY R. APPLEGATE, M.D. INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2006
-----------------------------------------------------
Last Update Date | 04/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6855 NOBLE AVE
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405-3729
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-901-0115
-----------------------------------------------------
Fax | 818-997-2895
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 908
-----------------------------------------------------
City | ORANGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92856-6908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-901-0115
-----------------------------------------------------
Fax | 818-997-2895
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. GREGORY R. APPLEGATE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 818-901-0115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------