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NPI Code Detail

MEDICARE: RADIOLOGY CONSULTANTS MEDICAL GROUP, INC

MEDICARE: RADIOLOGY CONSULTANTS MEDICAL GROUP, INC
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
12085R0202XDiagnostic Radiology PhysicianC42029CA
22085R0202XDiagnostic Radiology PhysicianG40576CA

General Provider Information

NPI Number : 1669463675
Entity Type Code : Organization
Provider Name (Legal Business Name) : RADIOLOGY CONSULTANTS MEDICAL GROUP, INC
Provider Business Mailing Address
First Line : PO BOX 548
Second Line :
City : SHERMAN
State : TX
Zip : 75091-0548
Country : US
Telephone Number : 903-465-1857
Fax Number : 903-327-8023
Provider Business Practice Location Address
First Line : 525 W ACACIA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95203-2405
Country : US
Telephone Number : 903-465-1857
Fax Number : 903-327-8023
Authorized Official
Title or Position : OWNER/MANAGER
Name : DR. NAZAR R ALSAFFAR
Credential : MD
Telephone Number : 903-465-1581
Provider Enumeration Date : 10/31/2005
Last Update Date : 11/16/2016

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