Healthcare Provider Details

I. General information

NPI: 1841376464
Provider Name (Legal Business Name): PATRICK TEDFORD, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 W EAST AVE
CHICO CA
95926-7201
US

IV. Provider business mailing address

643 W EAST AVE
CHICO CA
95926-7201
US

V. Phone/Fax

Practice location:
  • Phone: 530-342-0502
  • Fax: 530-342-2978
Mailing address:
  • Phone: 530-342-0502
  • Fax: 530-342-2978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA24629
License Number StateCA

VIII. Authorized Official

Name: PATRICK TEDFORD
Title or Position: CEO, MD
Credential: MD
Phone: 530-342-0502