=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073920336
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIBETH PREWITT SAYRE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2014
-----------------------------------------------------
Last Update Date | 07/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1335 GALINDO ST
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-687-4451
-----------------------------------------------------
Fax | 925-687-4450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1335 GALINDO ST
-----------------------------------------------------
City | CONCORD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-687-4451
-----------------------------------------------------
Fax | 925-687-4450
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0901X
-----------------------------------------------------
Taxonomy Name | Public Health & General Preventive Medicine Physician
-----------------------------------------------------
License Number | G24026
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------