Basic Information
| Provider Information | |||||||||
| NPI: | 1962746149 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER NEUROLOGY OF BAKERSFIELD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3838 SAN DIMAS ST | ||||||||
| Address2: | BLDG A SUITE 250 | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933012284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613235300 | ||||||||
| FaxNumber: | 6613235455 | ||||||||
| Practice Location | |||||||||
| Address1: | 3838 SAN DIMAS ST | ||||||||
| Address2: | BLDG A SUITE 250 | ||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933012284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613235300 | ||||||||
| FaxNumber: | 6613235455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2012 | ||||||||
| LastUpdateDate: | 11/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | LAUGHLIN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT OF THE CORPORATION | ||||||||
| AuthorizedOfficialTelephone: | 6613235300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |
No ID Information.