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Organization
PULMONARY CONSULTANTS AND PRIMARY CARE PHYSICIANS MEDICAL GROUP INC
Active
Organization
PULMONARY CONSULTANTS AND PRIMARY CARE PHYSICIANS MEDICAL GROUP INC
Active
Other names
La Veta Office
Organization subpart
No
Provider details
NPI number
Authorized official
JACK STEWART MD (PRESIDENT - AUTHORIZED OFFICIAL)
(714) 639-9401
Entity
Organization
Contact information
Practice address
1010 W LA VETA AVE, SUITE 750, ORANGE, CA 92868-4304
(714) 361-6600
Mailing address
1010 W LA VETA AVE, SUITE 750, ORANGE, CA 92868-4312
(714) 361-6600
(714) 919-8804
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RP1001X
Pulmonary Disease Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912919804
TYPE 2 NPI
CA
05
—
1912919804
—
CA
01
—
CG5665
RAILROAD MEDICARE GROUP NUMBER
CA
05
—
GR0003350
—
CA
01
—
W1514
TYPE 2 PTAN
CA
Enumeration date
06/12/2008
Last updated
06/21/2017
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