MEDICARE: INTERNAL MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ82813Z	OTHER		MEDICAL

General Provider Information

NPI Number	:	1164499737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICAL GROUP

Provider Business Mailing Address
First Line	:	16671 YORBA LINDA BLVD
Second Line	:	STE 200
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-2046
Country	:	US
Telephone Number	:	714-996-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	16671 YORBA LINDA BLVD STE 200
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-2046
Country	:	US
Telephone Number	:	714-996-3700
Fax Number	:

Authorized Official
Title or Position	:	GASTROENTEROLOGIST
Name	:	DAVID JARETT CHAPMAN
Credential	:	MD
Telephone Number	:	714-996-3700

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	03/31/2014

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Directions to “INTERNAL MEDICAL GROUP ” Practice Location

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