Provider Demographics
NPI:1386751741
Name:APPLEGATE, GREGORY R (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:R
Last Name:APPLEGATE
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 1:6855 NOBLE AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3729
Mailing Address - Country:US
Mailing Address - Phone:818-901-0115
Mailing Address - Fax:818-901-9529
Practice Address - Street 1:6855 NOBLE AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3729
Practice Address - Country:US
Practice Address - Phone:818-901-0115
Practice Address - Fax:818-901-9529
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG573332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G573330Medicaid
CATD076OtherPTAN
CAAU601ZMedicare PIN
CAE55604Medicare UPIN
CATD076OtherPTAN
CA00G573330Medicaid
CAWG57333NMedicare PIN