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General NPI Number Information
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NPI Number | 1053449850
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY MEDICAL ASSOCIATES OF SONOMA
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 1210 SONOMA AVE SUITE B
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City | SANTA ROSA
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State | CA
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Zip | 95405
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Country | US
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Telephone | 707-544-5093
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Fax | 707-528-8444
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Provider Business Mailing Address
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Address Line | 1210 SONOMA AVE SUITE B
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City | SANTA ROSA
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State | CA
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Zip | 95405
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Country | US
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Telephone | 707-544-5093
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Fax | 707-528-8444
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD M. AULD JR.
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Credential | M.D.
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Telephone | 707-575-8570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G72891
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License Number State | CA
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