MEDICARE: REDWOOD REGIONAL MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RH0000X	Hematology (Internal Medicine) Physician
2	207RX0202X	Medical Oncology Physician
3	363L00000X	Nurse Practitioner
4	207RH0003X	Hematology & Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477629855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDWOOD REGIONAL MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	652 PETALUMA AVE STE B
Second Line	:
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4266
Country	:	US
Telephone Number	:	707-823-8565
Fax Number	:	707-823-7851

Provider Business Practice Location Address
First Line	:	652 PETALUMA AVE STE B
Second Line	:
City	:	SEBASTOPOL
State	:	CA
Zip	:	95472-4266
Country	:	US
Telephone Number	:	707-823-8565
Fax Number	:	707-823-7851

Authorized Official
Title or Position	:	MD - RADIOLOGIST
Name	:	DAVID H SCHMIDT
Credential	:	M.D.
Telephone Number	:	707-546-4062

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	11/15/2007

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Directions to “REDWOOD REGIONAL MEDICAL GROUP, INC. ” Practice Location

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