Provider Demographics
NPI:1528365319
Name:NATION MEDICAL GROUP
Entity Type:Organization
Organization Name:NATION MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:NATION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-757-9799
Mailing Address - Street 1:1123 W STRUCK AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92867-3529
Mailing Address - Country:US
Mailing Address - Phone:714-757-9799
Mailing Address - Fax:714-202-0080
Practice Address - Street 1:954 W FOOTHILL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3782
Practice Address - Country:US
Practice Address - Phone:909-985-8230
Practice Address - Fax:909-985-4827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44036207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty