Organization
SPINE AND NEUROSURGICAL TRAUMA ASSOCIATES OF NORTHERN CALIFORNIA
Active
Other names
NorCal Neurosurgery Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT GLICKMAN DO (PRESIDENT)
(707) 799-5911
Entity
Organization
Contact information
Practice address
4690 HOEN AVE, SANTA ROSA, CA 95405-7823
(707) 799-5911
Mailing address
1275 4TH ST, PMB 646, SANTA ROSA, CA 95404-4057
(707) 799-5911
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
13305
CA
2084V0102X
Vascular Neurology Physician
13305
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3102403
—
OH
Enumeration date
09/17/2014
Last updated
09/17/2014
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