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Organization
MISCO MEDICAL GROUP INC
Active
Organization
MISCO MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMISON DEREK FERAMISCO M.D. (CEO/OWNER)
(877) 870-9301
Entity
Organization
Contact information
Practice address
1125 SIR FRANCIS DRAKE BLVD, KENTFIELD, CA 94904-1418
(877) 870-9301
(877) 882-0462
Mailing address
31566 RAILROAD CANYON RD, 2-130, CANYON LAKE, CA 92587-9446
(877) 870-9301
(877) 882-0462
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A105161
CA
Other
Enumeration date
05/25/2012
Last updated
05/25/2012
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