Basic Information
| Provider Information | |||||||||
| NPI: | 1366628224 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SUTTER MEDICAL GROUP OF THE REDWOODS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3883 AIRWAY DR STE 300 | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954031671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075218809 | ||||||||
| FaxNumber: | 7075218835 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 DOYLE PARK DR | ||||||||
| Address2: | STE. 303 | ||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954054558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075751833 | ||||||||
| FaxNumber: | 7075751892 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2008 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | ROCKSTROH | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING ADMINISTRATIVE ASSIST | ||||||||
| AuthorizedOfficialTelephone: | 7075218809 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.