Identity Medical Group, Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

IDENTITY MEDICAL GROUP, INC.

Practice address

751 E Daily Dr
Suite 120
Camarillo, CA 93010-6076

Phone

(805) 256-7810

Fax

(805) 256-7840

NPI assigned

Dec 17, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary M. Deutsch,, M.D.

Title

General Partner

Phone

(805) 256-7810

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479427200000",
    "number": "1326384512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "751 E DAILY DR",
            "address_2": "SUITE 120",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930106076",
            "telephone_number": "805-256-7810",
            "fax_number": "805-256-7840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 E DAILY DR",
            "address_2": "SUITE 120",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930106076",
            "telephone_number": "805-256-7810",
            "fax_number": "805-256-7840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDENTITY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-17",
        "last_updated": "2016-11-18",
        "status": "A",
        "authorized_official_last_name": "DEUTSCH,",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "GENERAL PARTNER",
        "authorized_official_telephone_number": "805-256-7810",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Camarillo, CA
• Providers in Camarillo, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.