Healthcare Provider Details

I. General information

NPI: 1184778839
Provider Name (Legal Business Name): DONNER PASS MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10956 DONNER PASS RD SUITE 260
TRUCKEE CA
96161-4861
US

IV. Provider business mailing address

10956 DONNER PASS RD SUITE 260
TRUCKEE CA
96161-4861
US

V. Phone/Fax

Practice location:
  • Phone: 530-582-6400
  • Fax: 530-582-6991
Mailing address:
  • Phone: 530-582-6400
  • Fax: 530-582-6991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG069661
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8850
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG069661
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number8850
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG069661
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number8850
License Number StateNV
# 7
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberG069661
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number8850
License Number StateNV

VIII. Authorized Official

Name: DR. GREGORY TIRDEL
Title or Position: PHYSICIAN
Credential: MD
Phone: 530-582-6400