Healthcare Provider Details

I. General information

NPI: 1275564528
Provider Name (Legal Business Name): WEBSTER ORTHOPAEDIC MEDICAL GROUP, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19842 LAKE CHABOT RD
CASTRO VALLEY CA
94546-4002
US

IV. Provider business mailing address

200 PORTER DR SUITE 215
SAN RAMON CA
94583-1587
US

V. Phone/Fax

Practice location:
  • Phone: 925-556-7320
  • Fax: 925-479-0231
Mailing address:
  • Phone: 925-362-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN THEODORE SCWARTZ JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 510-238-1200