Provider Demographics
NPI:1790560225
Name:DRH MEDICAL GROUP
Entity Type:Organization
Organization Name:DRH MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOAGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-735-6453
Mailing Address - Street 1:2940 SUMMIT ST STE 2D
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3416
Mailing Address - Country:US
Mailing Address - Phone:415-735-6453
Mailing Address - Fax:415-548-2181
Practice Address - Street 1:400 30TH ST STE 407
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3321
Practice Address - Country:US
Practice Address - Phone:415-735-6453
Practice Address - Fax:415-548-2181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty