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General NPI Number Information
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NPI Number | 1972683654
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Entity Type | Organization
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Legal Business Name | SANTA ROSA GASTROENTEROLOGY MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 10/01/2008
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Provider Practice Location Address
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Address Line | 1210 SONOMA AVE SUITE B
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City | SANTA ROSA
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State | CA
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Zip | 95405
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Country | US
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Telephone | 707-544-5093
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Fax | 707-528-8444
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Provider Business Mailing Address
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Address Line | 1210 SONOMA AVE SUITE B
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City | SANTA ROSA
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State | CA
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Zip | 95405
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Country | US
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Telephone | 707-544-5093
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Fax | 707-528-8444
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Authorized Official
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Title or Position | MD DIRECTOR
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Name | ROBERT LOGAN FAUST
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Credential | MD
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Telephone | 707-544-5093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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