Healthcare Provider Details

I. General information

NPI: 1902086374
Provider Name (Legal Business Name): HEPATOLOGY AND GASTROENTEROLOGY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1383 N MCDOWELL BLVD STE 110
PETALUMA CA
94954-1190
US

IV. Provider business mailing address

1383 N MCDOWELL BLVD STE 110
PETALUMA CA
94954-1190
US

V. Phone/Fax

Practice location:
  • Phone: 707-766-9852
  • Fax: 707-766-8431
Mailing address:
  • Phone: 415-668-9371
  • Fax: 415-668-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA44200
License Number StateCA

VIII. Authorized Official

Name: STEPHEN LEO STEADY
Title or Position: MD
Credential: MD
Phone: 707-766-9852