Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A65392 | CA |
N | 207XS0117X | Orthopaedic Spine Surgeon | A65392 | CA |
NPI | 1063467116 |
---|---|
Provider Name | Gary M Alegre |
First Address | Stockton, CA 95204-5508 |
Second Address | Stockton, CA 95204-5508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 29/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0368640001 | DMERC (01) | |
195690700 | USDL (01) | |
C6P159090 | CGP (01) | |
H47245 | (02) | |
P00051180 | RR MEDICARE (01) | |
ZZZ71793Z | (05) | CA |