Basic Information
| Provider Information | |||||||||
| NPI: | 1922109511 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY PHYSICIANS, INC., A MEDICAL CORPORATION | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | FAMILY PHYSICIANS INC, A MEDICAL CORPORATION | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1233 PLUMAS ST | ||||||||
| Address2: | STE A | ||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306712020 | ||||||||
| FaxNumber: | 5306716797 | ||||||||
| Practice Location | |||||||||
| Address1: | 1233 PLUMAS ST | ||||||||
| Address2: | STE A | ||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95991 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306712020 | ||||||||
| FaxNumber: | 5306716797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 11/13/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | J | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5306712020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | A450730 | 01 | CA | LICENSE | OTHER | BC9338838 | 01 | CA | DEA | OTHER | A95951 | 01 | CA | LICENSE | OTHER | BR1662875 | 01 | CA | DEA | OTHER | GR0070950 | 05 | CA | MEDICAID | MM0498419 | 01 | DEA | OTHER | 20A603930 | 01 | LICENSE PIN | OTHER | AM2876780 | 01 | DEA | OTHER | PA13423 | 01 | LICENSE PIN | OTHER |