Provider Demographics
NPI:1669575841
Name:SIERRA DOCTORS MEDICAL GROUP INC
Entity type:Organization
Organization Name:SIERRA DOCTORS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BOEYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-885-0344
Mailing Address - Street 1:275 GRASS VALLEY HWY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-4533
Mailing Address - Country:US
Mailing Address - Phone:530-885-0344
Mailing Address - Fax:530-885-5046
Practice Address - Street 1:275 GRASS VALLEY HWY
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4533
Practice Address - Country:US
Practice Address - Phone:530-885-0344
Practice Address - Fax:530-885-8967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC033573207P00000X
CACO33573207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7401590001Medicare NSC
CAA35314Medicare UPIN