Provider Demographics
NPI:1275564528
Name:WEBSTER ORTHOPAEDIC MEDICAL GROUP, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:WEBSTER ORTHOPAEDIC MEDICAL GROUP, A PROFESSIONAL CORPORATION
Other - Org Name:WEBSTER ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:SCWARTZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:510-238-1200
Mailing Address - Street 1:200 PORTER DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1587
Mailing Address - Country:US
Mailing Address - Phone:925-362-2166
Mailing Address - Fax:
Practice Address - Street 1:19842 LAKE CHABOT RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4002
Practice Address - Country:US
Practice Address - Phone:925-556-7320
Practice Address - Fax:925-479-0231
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEBSTER ORTHOPAEDIC MEDICAL GROUP, A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ45498ZMedicaid
CA0571260003Medicare NSC