Healthcare Provider Details

I. General information

NPI: 1982726576
Provider Name (Legal Business Name): BAY SURGEONS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3798 JANES RD STE 6
ARCATA CA
95521-4753
US

IV. Provider business mailing address

1225 MARSHALL ST STE 7
CRESCENT CITY CA
95531-2281
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-2279
  • Fax: 707-464-9593
Mailing address:
  • Phone: 707-464-6372
  • Fax: 707-464-9593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number00G569970
License Number StateCA

VIII. Authorized Official

Name: DR. ALAN F KREMEN
Title or Position: CEO
Credential: MD
Phone: 530-532-4400