Basic Information
Provider Information
NPI: 1982726576
EntityType: 2
ReplacementNPI:  
OrganizationName: BAY SURGEONS MEDICAL GROUP
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Mailing Information
Address1: 1225 MARSHALL ST
Address2: STE 7
City: CRESCENT CITY
State: CA
PostalCode: 955312281
CountryCode: US
TelephoneNumber: 7074646372
FaxNumber: 7074649593
Practice Location
Address1: 3798 JANES RD
Address2: STE 6
City: ARCATA
State: CA
PostalCode: 955214753
CountryCode: US
TelephoneNumber: 7078222279
FaxNumber: 7074649593
Other Information
ProviderEnumerationDate: 04/04/2007
LastUpdateDate: 11/10/2011
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AuthorizedOfficialLastName: KREMEN
AuthorizedOfficialFirstName: ALAN
AuthorizedOfficialMiddleName: F
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 5305324400
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X00G569970CAY193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgery 

ID Information
IDTypeStateIssuerDescription
00G56997005CA MEDICAID


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