Healthcare Provider Details

I. General information

NPI: 1487651600
Provider Name (Legal Business Name): PATRICIA DRIER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 PETALUMA AVE #A
SEBASTOPOL CA
95472-4224
US

IV. Provider business mailing address

555 PETALUMA AVE #A
SEBASTOPOL CA
95472-4224
US

V. Phone/Fax

Practice location:
  • Phone: 707-823-3210
  • Fax: 707-823-1710
Mailing address:
  • Phone: 707-823-3210
  • Fax: 707-823-1710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG53201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: