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NPI Code Detail

MEDICARE: SAN PABLO ANESTHESIOLOGY MEDICAL CORPORATION

MEDICARE: SAN PABLO ANESTHESIOLOGY MEDICAL CORPORATION
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
1207L00000XAnesthesiology PhysicianN/A

General Provider Information

NPI Number : 1881642692
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAN PABLO ANESTHESIOLOGY MEDICAL CORPORATION
Provider Business Mailing Address
First Line : 8905 SW NIMBUS AVE
Second Line : STE 300
City : BEAVERTON
State : OR
Zip : 97008-7136
Country : US
Telephone Number : 503-372-2740
Fax Number : 503-372-2754
Provider Business Practice Location Address
First Line : 2000 VALE RD
Second Line :
City : SAN PABLO
State : CA
Zip : 94806-3808
Country : US
Telephone Number : 510-970-5000
Fax Number : 510-970-5761
Authorized Official
Title or Position : PRESIDENT
Name : DR. MERTON B. GOODE
Credential : MD
Telephone Number : 503-372-2740
Provider Enumeration Date : 05/04/2006
Last Update Date : 08/22/2020

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Directions to “SAN PABLO ANESTHESIOLOGY MEDICAL CORPORATION ” Practice Location

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