Provider Demographics
NPI:1053473173
Name:SANTA MONICA ORTHOPAEDIC GROUP
Entity Type:Organization
Organization Name:SANTA MONICA ORTHOPAEDIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOWEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-829-2663
Mailing Address - Street 1:1301 20TH ST
Mailing Address - Street 2:150
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2050
Mailing Address - Country:US
Mailing Address - Phone:310-829-2663
Mailing Address - Fax:
Practice Address - Street 1:1301 20TH ST
Practice Address - Street 2:150
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2050
Practice Address - Country:US
Practice Address - Phone:310-829-2663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty