| Full Name | |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | Tb 156, Davis, California |
| Authorized Official Name and Position | William H Mcgowan (CFO) |
| Authorized Official Contact | 9167349129 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4900 Broadway Ste 2500 Sacramento CA 95820-1532 Ph: (916) 734-9200 | Tb 156 Davis CA 95616 Ph: (530) 752-2714 |
| NPI Number | 1275526329 |
|---|---|
| Provider Enumeration Date | 08/24/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275526329 | NPI | - | NPPES |
| LAB58715F | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
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