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General NPI Number Information
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NPI Number | 1699820969
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Entity Type | Organization
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Legal Business Name | EAST BAY ORTHOPAEDIC SPECIALISTS MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 10/07/2009
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Provider Practice Location Address
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Address Line | 350 30TH ST STE 530
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City | OAKLAND
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State | CA
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Zip | 94609-3426
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Country | US
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Telephone | 510-238-1468
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Fax | 510-839-3796
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Provider Business Mailing Address
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Address Line | 350 30TH ST STE 530
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City | OAKLAND
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State | CA
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Zip | 94609-3426
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Country | US
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Telephone | 510-238-1468
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Fax | 510-839-3796
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEORGE ARTHUR PUGH
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Credential | M.D.
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Telephone | 510-238-1468
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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 | G38318
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License Number State | CA
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