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General NPI Number Information
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NPI Number | 1679656490
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Entity Type | Organization
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Legal Business Name | TRAUMATOLOGY
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 711 D STREET SUITE 102
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City | SAN RAFAEL
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State | CA
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Zip | 94901
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Country | US
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Telephone | 415-457-7414
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Fax | 415-460-2750
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Provider Business Mailing Address
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Address Line | 711 D STREET SUITE 102
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City | SAN RAFAEL
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State | CA
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Zip | 94901
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Country | US
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Telephone | 415-457-7414
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Fax | 415-460-2750
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Authorized Official
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Title or Position | CEO
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Name | DR. PETER BARRY
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Credential | MD
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Telephone | 415-457-7414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | G23690
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License Number State |
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