Provider Demographics
NPI:1164569463
Name:BAROMEDICAL PHYSICIAN ASSOCIATES MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:BAROMEDICAL PHYSICIAN ASSOCIATES MEDICAL GROUP, INC
Other - Org Name:ORANGE COUNTY WOUND AND HYPERBARIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:JONATHON
Authorized Official - Last Name:WERNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-973-8777
Mailing Address - Street 1:720 N TUSTIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3606
Mailing Address - Country:US
Mailing Address - Phone:174-973-8777
Mailing Address - Fax:714-973-8778
Practice Address - Street 1:720 N TUSTIN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3606
Practice Address - Country:US
Practice Address - Phone:174-973-8777
Practice Address - Fax:714-973-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000G66730Medicaid
CAE92393Medicare UPIN
CAW16510Medicare PIN