Provider Demographics
NPI:1275511644
Name:GENERAL SURGERY MEDICAL GROUP OF VENTURA COUNTY
Entity Type:Organization
Organization Name:GENERAL SURGERY MEDICAL GROUP OF VENTURA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-485-8722
Mailing Address - Street 1:1700 N ROSE AVE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-3790
Mailing Address - Country:US
Mailing Address - Phone:805-485-8722
Mailing Address - Fax:805-485-9311
Practice Address - Street 1:1700 N ROSE AVE
Practice Address - Street 2:SUITE 430
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3790
Practice Address - Country:US
Practice Address - Phone:805-485-8722
Practice Address - Fax:805-485-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0027300Medicaid
CAYYY49967YOtherBLUE SHIELD
CAW10349Medicare ID - Type UnspecifiedMEDICARE