Provider Demographics
NPI:1922689496
Name:DOC INDUSTRIAL MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:DOC INDUSTRIAL MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:RON-PAUL
Authorized Official - Middle Name:DARRON
Authorized Official - Last Name:DUNNUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-457-4717
Mailing Address - Street 1:4510 EXECUTIVE DR STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3022
Mailing Address - Country:US
Mailing Address - Phone:858-457-4717
Mailing Address - Fax:
Practice Address - Street 1:4510 EXECUTIVE DR STE 107
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3022
Practice Address - Country:US
Practice Address - Phone:858-457-4717
Practice Address - Fax:858-457-0470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty