Provider Demographics
NPI:1093793242
Name:HEDMAN, BRON CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:BRON
Middle Name:CHRISTOPHER
Last Name:HEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6960 DESTINY DR
Mailing Address - Street 2:STE 100
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-2995
Mailing Address - Country:US
Mailing Address - Phone:916-624-1777
Mailing Address - Fax:916-624-1770
Practice Address - Street 1:6805 FIVE STAR BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2684
Practice Address - Country:US
Practice Address - Phone:916-624-3500
Practice Address - Fax:916-624-3351
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66121207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG86867Medicare UPIN
CAZZZ26454ZMedicare ID - Type Unspecified