Basic Information
| Provider Information | |||||||||
| NPI: | 1063467116 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALEGRE | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2488 N CALIFORNIA | ||||||||
| Address2: | ALPINE ORTHOPAEDIC MEDICAL GROUP INC | ||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952045508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099483333 | ||||||||
| FaxNumber: | 2099482665 | ||||||||
| Practice Location | |||||||||
| Address1: | 2488 N CALIFORNIA | ||||||||
| Address2: | ALPINE ORTHOPAEDIC MEDICAL GROUP INC | ||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 952045508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099483333 | ||||||||
| FaxNumber: | 2099482665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 05/29/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | A65392 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0117X | A65392 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 0368640001 | 01 | DMERC | OTHER | ZZZ71793Z | 05 | CA | MEDICAID | P00051180 | 01 | RR MEDICARE | OTHER | 195690700 | 01 | USDL | OTHER | C6P159090 | 01 | CGP | OTHER |