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General NPI Number Information
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NPI Number | 1659467892
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Entity Type | Organization
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Legal Business Name | LODI UROLOGICAL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 830 S HAM LN SUITE 26
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City | LODI
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State | CA
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Zip | 95242-7510
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Country | US
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Telephone | 209-368-6661
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Fax | 209-333-7655
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Provider Business Mailing Address
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Address Line | 830 S HAM LN SUITE 26
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City | LODI
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State | CA
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Zip | 95242-7510
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Country | US
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Telephone | 209-368-6661
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Fax | 209-333-7655
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Authorized Official
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Title or Position | PRESIDENT
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Name | N. ERICK ALBERT
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Credential | M.D.
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Telephone | 209-368-6661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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