Healthcare Provider Details

I. General information

NPI: 1194704973
Provider Name (Legal Business Name): DAVID A SOUTH MD & KIM M ALBRIDGE MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 GREEN VALLEY ROAD
FREEDOM CA
95019
US

IV. Provider business mailing address

204 GREEN VALLEY ROAD
FREEDOM CA
95019
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-2005
  • Fax: 831-728-3310
Mailing address:
  • Phone: 831-728-2005
  • Fax: 831-728-3310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID A SOUTH
Title or Position: PRESIDENT
Credential: MD
Phone: 831-728-2005