Healthcare Provider Details

I. General information

NPI: 1174825947
Provider Name (Legal Business Name): GOLD COUNTRY EMERGENCY PHYSICIANS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 DELBON AVE
TURLOCK CA
95382-2016
US

IV. Provider business mailing address

PO BOX 661105
ARCADIA CA
91066-1105
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-4200
  • Fax:
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN P. MARON
Title or Position: OWNER
Credential: M.D.
Phone: 925-482-2811