Provider Demographics
NPI:1255439923
Name:MCBRIDE, MEREDITH R (MD)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:R
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:
Other - Last Name:BASSHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 GREENLEY RD
Mailing Address - Street 2:SUITE 923
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5287
Mailing Address - Country:US
Mailing Address - Phone:209-536-5090
Mailing Address - Fax:209-536-3585
Practice Address - Street 1:900 GREENLEY RD
Practice Address - Street 2:SUITE 923
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5287
Practice Address - Country:US
Practice Address - Phone:209-536-5090
Practice Address - Fax:209-536-3585
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA998312086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery