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Organization
NORTHCOAST FAMILY PRACTICE MEDICAL GROUP INC
Active
Organization
NORTHCOAST FAMILY PRACTICE MEDICAL GROUP INC
Active
Other names
Eureka Allergy Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ANNE E TAIT MD (CEO)
(707) 445-3063
Entity
Organization
Contact information
Practice address
2505 LUCAS ST, EUREKA, CA 95501-3340
(707) 445-3063
(707) 442-6602
Mailing address
2505 LUCAS ST, EUREKA, CA 95501-3340
(707) 445-3063
(707) 442-6602
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G62640
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G626400
—
CA
Enumeration date
09/14/2006
Last updated
08/22/2020
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