Provider Demographics
NPI:1891067344
Name:PHYSICIAN PARTNERS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:PHYSICIAN PARTNERS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-781-3800
Mailing Address - Street 1:3719 ARLINGTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2652
Mailing Address - Country:US
Mailing Address - Phone:951-781-3800
Mailing Address - Fax:
Practice Address - Street 1:3719 ARLINGTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2652
Practice Address - Country:US
Practice Address - Phone:951-781-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty