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Organization
PARADISE MEDICAL GROUP, INC.
Active
Organization
PARADISE MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD E. THORP M.D. (PRESIDENT/CEO)
(530) 872-6650
Entity
Organization
Contact information
Practice address
6470 PENTZ RD, SUITE A, PARADISE, CA 95969-3674
(530) 872-6650
(530) 872-6653
Mailing address
6470 PENTZ RD, SUITE A, PARADISE, CA 95969-3674
(530) 872-6650
(530) 872-6653
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
208M00000X
Hospitalist Physician
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ21920Z
BLUE SHIELD
CA
Enumeration date
11/17/2005
Last updated
01/11/2012
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