Basic Information
Provider Information
NPI: 1154389146
EntityType: 2
ReplacementNPI:  
OrganizationName: BEAR CREEK ANESTHESIA MEDICAL GROUP
LastName:  
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Mailing Information
Address1: PO BOX 7096
Address2:  
City: STOCKTON
State: CA
PostalCode: 95267
CountryCode: US
TelephoneNumber: 2099567725
FaxNumber: 2099567733
Practice Location
Address1: 333 MERCY AVE
Address2:  
City: MERCED
State: CA
PostalCode: 953408319
CountryCode: US
TelephoneNumber: 2095645000
FaxNumber: 2093857838
Other Information
ProviderEnumerationDate: 05/02/2006
LastUpdateDate: 12/12/2011
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: BRONS
AuthorizedOfficialFirstName: RONALD
AuthorizedOfficialMiddleName: E
AuthorizedOfficialTitleorPosition: GROUP PRESIDENT
AuthorizedOfficialTelephone: 2095645000
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
GR008804005CA MEDICAID


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