Healthcare Provider Details

I. General information

NPI: 1316034630
Provider Name (Legal Business Name): REDWOOD REGIONAL MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 S DORA ST BLDG H
UKIAH CA
95482-8325
US

IV. Provider business mailing address

1165 S DORA ST BLDG H
UKIAH CA
95482-8325
US

V. Phone/Fax

Practice location:
  • Phone: 707-463-3636
  • Fax: 707-463-2714
Mailing address:
  • Phone: 707-463-3636
  • Fax: 707-463-2714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

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