MEDICARE: MANDEEP SINGH NAGRA MB,BS

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	207R00000X	Internal Medicine Physician	A81237	CA

General Provider Information

NPI Number	:	1851325914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDEEP SINGH NAGRA MB,BS

Provider Business Mailing Address
First Line	:	4941 N GARDNER RIVER WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-4760
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3315 CHANATE RD STE 1E
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-1740
Country	:	US
Telephone Number	:	707-570-3855
Fax Number	:	707-570-3850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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