Healthcare Provider Details

I. General information

NPI: 1215016993
Provider Name (Legal Business Name): REDWOOD REGIONAL MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 STEELE LN
SANTA ROSA CA
95403-3127
US

IV. Provider business mailing address

347 ANDRIEUX ST STE 1
SONOMA CA
95476-6811
US

V. Phone/Fax

Practice location:
  • Phone: 707-935-5460
  • Fax: 707-935-5466
Mailing address:
  • Phone: 707-935-5460
  • Fax: 707-935-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID H. SCHMIDT
Title or Position: M.D./RADIOLOGIST
Credential: M.D.
Phone: 707-546-4062