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General NPI Number Information
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NPI Number | 1326236449
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Entity Type | Organization
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Legal Business Name | NEW DIRECTIONS MEDICAL CENTER INC
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 2135 ARMORY DR SUITE 100
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City | SANTA ROSA
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State | CA
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Zip | 95401-3610
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Country | US
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Telephone | 707-575-1700
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Fax | 707-575-1755
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Provider Business Mailing Address
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Address Line | 2135 ARMORY DR SUITE 100
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City | SANTA ROSA
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State | CA
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Zip | 95401-3610
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Country | US
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Telephone | 707-575-1700
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Fax | 707-575-1755
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN S MOORE
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Credential |
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Telephone | 707-575-1700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | G55246
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License Number State | CA
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