Healthcare Provider Details

I. General information

NPI: 1861499014
Provider Name (Legal Business Name): PRIER MEDICAL CLINIC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 POSADA LN STE D
TEMPLETON CA
93465-4054
US

IV. Provider business mailing address

PO BOX 1335
TEMPLETON CA
93465-1335
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-0880
  • Fax: 805-434-5275
Mailing address:
  • Phone: 805-434-0880
  • Fax: 805-434-5275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG75247
License Number StateCA

VIII. Authorized Official

Name: RICHARD CHARLES PRIER
Title or Position: CEO/PHYSICIAN
Credential: M.D.
Phone: 805-434-0880