MEDICARE: DR. BARRY GORDON GWARTZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G12309	CA

General Provider Information

NPI Number	:	1265683767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY GORDON GWARTZ M.D.

Provider Business Mailing Address
First Line	:	8592 LOOKOUT MOUNTAIN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-1814
Country	:	US
Telephone Number	:	323-655-4701
Fax Number	:	310-641-8685

Provider Business Practice Location Address
First Line	:	8592 LOOKOUT MOUNTAIN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046-1814
Country	:	US
Telephone Number	:	323-655-4701
Fax Number	:	310-641-8685

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2008
Last Update Date	:	10/02/2008

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