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General NPI Number Information
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NPI Number | 1639383847
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Entity Type | Organization
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Legal Business Name | GOLDEN EMPIRE PATHOLOGY MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1830 FLOWER ST
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City | BAKERSFIELD
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State | CA
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Zip | 93305-4144
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Country | US
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Telephone | 661-326-2256
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Fax | 661-872-3366
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Provider Business Mailing Address
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Address Line | 1830 FLOWER ST
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City | BAKERSFIELD
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State | CA
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Zip | 93305-4144
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Country | US
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Telephone | 661-326-2256
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Fax | 661-872-3366
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Authorized Official
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Title or Position | OWNER
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Name | PHILIP L. DUTT
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Credential | MD
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Telephone | 661-326-2256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number | G80286
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License Number State | CA
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