Healthcare Provider Details

I. General information

NPI: 1699739912
Provider Name (Legal Business Name): BOBBY GENE FIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 MONTGOMERY DR
SANTA ROSA CA
95405-4801
US

IV. Provider business mailing address

3533 OAK HAVEN CT
SANTA ROSA CA
95404-1309
US

V. Phone/Fax

Practice location:
  • Phone: 707-303-8307
  • Fax: 707-303-1992
Mailing address:
  • Phone: 707-529-7321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG22056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: