Basic Information
| Provider Information | |||||||||
| NPI: | 1376651265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEIFER | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 72057 HIGHWAY 111 | ||||||||
| Address2: | |||||||||
| City: | RANCHO MIRAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922704927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603467191 | ||||||||
| FaxNumber: | 7603467905 | ||||||||
| Practice Location | |||||||||
| Address1: | 72057 HIGHWAY 111 | ||||||||
| Address2: | |||||||||
| City: | RANCHO MIRAGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922704927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603467191 | ||||||||
| FaxNumber: | 7603467905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 08/19/2014 | ||||||||
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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 | 208800000X | 0418998 | KS | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | R3C49 | MO | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | G88841 | CA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 340016726 | 01 | RAILROAD MEDICARE | OTHER | 10775061 | 01 | BCBS | OTHER |