Healthcare Provider Details

I. General information

NPI: 1982883898
Provider Name (Legal Business Name): WEBSTER ORTHOPAEDIC MEDICAL GROUP, A PROFESSIONAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 01/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 DUBLIN BLVD SUITE 100
DUBLIN CA
94568-3113
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 Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN THEODORE SCHWARTZ
Title or Position: PRESIDENT
Credential: MD
Phone: 925-362-2166