Keith L Agre, MD, Medical Corporation

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

C24838 Issued in CA

Legal business name

KEITH L AGRE, MD, MEDICAL CORPORATION

Practice address

1125 S Beverly Dr
Suite 110
Los Angeles, CA 90035-1148

Phone

(310) 276-2033

Fax

(310) 858-3857

NPI assigned

Dec 4, 2007

Organization subpart

No

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

Authorized official

Name

Keith L Agre, M.D.

Title

President

Phone

(310) 276-2033

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196726400000",
    "number": "1760664411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1125 S BEVERLY DR",
            "address_2": "SUITE 110",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900351148",
            "telephone_number": "310-276-2033",
            "fax_number": "310-858-3857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1125 S BEVERLY DR",
            "address_2": "SUITE 110",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900351148",
            "telephone_number": "310-276-2033",
            "fax_number": "310-858-3857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEITH L AGRE, MD, MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2007-12-04",
        "status": "A",
        "authorized_official_last_name": "AGRE",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-276-2033",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CA",
            "license": "C24838",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Medical Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2007; 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.