| Mill Valley Medical Group | |
|
711 D St Suite 111 San Rafael CA 94901-3707 | |
| (415) 453-3030 | |
| Not Available |
| Full Name | Mill Valley Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 711 D St, San Rafael, California |
| Authorized Official Name and Position | Dana Tully-smith (VICE PRESIDENT) |
| Authorized Official Contact | 7075442632 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mill Valley Medical Group Po Box 3137 Rohnert Park CA 94927-3137 Ph: () - | Mill Valley Medical Group 711 D St Suite 111 San Rafael CA 94901-3707 Ph: (415) 453-3030 |
| NPI Number | 1780728246 |
|---|---|
| Provider Enumeration Date | 02/17/2007 |
| Last Update Date | 11/07/2008 |
| Medicare PECOS PAC ID | 3375602121 |
|---|---|
| Medicare Enrollment ID | O20081107000362 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780728246 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | G30229 (California) | Primary |
| Provider Name | David M Tully Smith |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1598890287 PECOS PAC ID: 7012076854 Enrollment ID: I20081107000355 |
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