Provider Demographics
NPI:1487609939
Name:ALTERMAN, RUSSELL S (DO)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:S
Last Name:ALTERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:20311 SW ACACIA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1733
Mailing Address - Country:US
Mailing Address - Phone:949-250-4244
Mailing Address - Fax:949-878-4886
Practice Address - Street 1:20311 SW ACACIA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1733
Practice Address - Country:US
Practice Address - Phone:949-250-4244
Practice Address - Fax:949-878-4886
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A68380OtherBLUE SHIELD
CA00AX68380OtherCALOPTIMA
CAP00074394OtherGOOD SAM RAILROAD
CA20A6838OtherBLUE CROSS
CA20AX68380Medicaid
CA20AX68380Medicaid
CA00AX68380OtherCALOPTIMA