1295725281 NPI number — DR. ALAN J DRUCKER M.D.

Table of content: DR. ALAN J DRUCKER M.D. (NPI 1295725281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295725281 NPI number — DR. ALAN J DRUCKER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRUCKER
Provider First Name:
ALAN
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295725281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2150 E TAHQUITZ CANYON WAY STE 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALM SPRINGS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92262-6818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-322-3705
Provider Business Mailing Address Fax Number:
888-392-6660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2150 E TAHQUITZ CANYON WAY STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM SPRINGS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92262-6818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-322-3705
Provider Business Practice Location Address Fax Number:
888-392-6660
Provider Enumeration Date:
10/21/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  G067228 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G672280 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G672280 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 260018554 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G672280 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".