Provider Demographics
NPI:1073709465
Name:GEORGE M. SCARMON, MD
Entity Type:Organization
Organization Name:GEORGE M. SCARMON, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCARMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-645-3388
Mailing Address - Street 1:1530 3RD ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-1562
Mailing Address - Country:US
Mailing Address - Phone:916-645-3388
Mailing Address - Fax:916-645-6159
Practice Address - Street 1:1530 3RD ST
Practice Address - Street 2:SUITE 106
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-1562
Practice Address - Country:US
Practice Address - Phone:916-645-3388
Practice Address - Fax:916-645-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G255140207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42696Medicare UPIN