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NPI Code Detail

MEDICARE: GARY L ZAGELBAUM, MD A PROF CORP

MEDICARE: GARY L ZAGELBAUM, MD A PROF CORP
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
1207RP1001XPulmonary Disease PhysicianG36630CA

General Provider Information

NPI Number : 1316049463
Entity Type Code : Organization
Provider Name (Legal Business Name) : GARY L ZAGELBAUM, MD A PROF CORP
Provider Business Mailing Address
First Line : 6200 WILSHIRE BLVD
Second Line : SUITE 1504
City : LOS ANGELES
State : CA
Zip : 90048-5816
Country : US
Telephone Number : 323-857-1323
Fax Number : 323-857-7089
Provider Business Practice Location Address
First Line : 6200 WILSHIRE BLVD
Second Line : SUITE 1504
City : LOS ANGELES
State : CA
Zip : 90048-5816
Country : US
Telephone Number : 323-857-1323
Fax Number : 323-857-7089
Authorized Official
Title or Position : PRESIDENT PHYSICIAN
Name : DR. GARY L ZAGELBAUM
Credential : MD
Telephone Number : 323-857-1323
Provider Enumeration Date : 09/01/2006
Last Update Date : 03/19/2013

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