Provider Demographics
NPI:1285748517
Name:ALTMAN, DONALD I (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:I
Last Name:ALTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16300 SAND CANYON AVE
Mailing Address - Street 2:SUITE 1011
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3711
Mailing Address - Country:US
Mailing Address - Phone:949-727-3999
Mailing Address - Fax:949-727-9053
Practice Address - Street 1:16300 SAND CANYON AVE
Practice Address - Street 2:SUITE 1011
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3711
Practice Address - Country:US
Practice Address - Phone:949-727-3999
Practice Address - Fax:949-727-9053
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG500412086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A92949Medicare UPIN
G50041Medicare ID - Type Unspecified