MEDICARE: SEASIDE DOCTORS ON DUTY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1023450855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEASIDE DOCTORS ON DUTY

Provider Business Mailing Address
First Line	:	100 WILSON RD
Second Line	:	100
City	:	MONTEREY
State	:	CA
Zip	:	93940-7885
Country	:	US
Telephone Number	:	831-649-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1513 FREMONT BLVD
Second Line	:	E1
City	:	SEASIDE
State	:	CA
Zip	:	93955-4319
Country	:	US
Telephone Number	:	831-899-1910
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MICHAEL MCMILLAN
Credential	:
Telephone Number	:	831-649-1000

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	07/29/2013

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Directions to “SEASIDE DOCTORS ON DUTY ” Practice Location

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