Provider Demographics
NPI:1053449850
Name:GASTROENTEROLOGY MEDICAL ASSOCIATES OF SONOMA
Entity Type:Organization
Organization Name:GASTROENTEROLOGY MEDICAL ASSOCIATES OF SONOMA
Other - Org Name:DIGESTIVE HEALTH CONSULTANTS OF NORTHERN CALIFORNIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:AULD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:707-575-8570
Mailing Address - Street 1:1210 SONOMA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405
Mailing Address - Country:US
Mailing Address - Phone:707-544-5093
Mailing Address - Fax:707-528-8444
Practice Address - Street 1:1210 SONOMA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405
Practice Address - Country:US
Practice Address - Phone:707-544-5093
Practice Address - Fax:707-528-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72891174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE77301Medicare UPIN
CAF384449Medicare UPIN
CAA27898Medicare UPIN