Provider Demographics
NPI:1629572425
Name:MEDPLUS A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MEDPLUS A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRAYDON
Authorized Official - Middle Name:W
Authorized Official - Last Name:SKEOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-397-4240
Mailing Address - Street 1:43525 CALLE DE VELARDO
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2628
Mailing Address - Country:US
Mailing Address - Phone:951-397-4240
Mailing Address - Fax:760-451-6636
Practice Address - Street 1:617 E ALVARADO ST
Practice Address - Street 2:
Practice Address - City:FALLBROOK
Practice Address - State:CA
Practice Address - Zip Code:92028
Practice Address - Country:US
Practice Address - Phone:951-397-4240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty