Healthcare Provider Details

I. General information

NPI: 1932461761
Provider Name (Legal Business Name): SEMON BADER, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SPRINGFIELD DR
WALNUT CREEK CA
94598-4341
US

IV. Provider business mailing address

1000 SPRINGFIELD DR
WALNUT CREEK CA
94598-4341
US

V. Phone/Fax

Practice location:
  • Phone: 650-515-1894
  • Fax:
Mailing address:
  • Phone: 650-515-1894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA98350
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberA98350
License Number StateCA

VIII. Authorized Official

Name: DR. SEMON BADER
Title or Position: CEO
Credential:
Phone: 650-515-1894