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General NPI Number Information
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NPI Number | 1467406603
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Entity Type | Organization
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Legal Business Name | SHASTA ANESTHESIA CONSULTANTS A MEDICAL GROUP INC
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 2175 ROSALINE AVE
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City | REDDING
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State | CA
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Zip | 96001-2509
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Country | US
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Telephone | 530-225-6000
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Fax | 530-243-0445
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Provider Business Mailing Address
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Address Line | 1134 PINE ST
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City | REDDING
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State | CA
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Zip | 96001
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Country | US
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Telephone | 530-221-3727
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN W MOON
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Credential | MD
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Telephone | 530-225-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G80229
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License Number State | CA
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