Organization
FOLSOM OBSTETRICS & GYNECOLOGY MEDICAL GROUP INC
Active
Other names
FOLSOM OBSTETRICS AND GYNECOLOGY MEDICAL GROUP INC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY RICHARD CRAGUN M.D. (OWNER PRESIDENT)
(916) 983-3500
Entity
Organization
Contact information
Practice address
1735 CREEKSIDE DR, FOLSOM, CA 95630-3457
(916) 983-3500
(916) 983-8437
Mailing address
9474 SWAN LAKE DR, GRANITE BAY, CA 95746-7205
(916) 797-6004
(916) 797-6004
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G51481
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ18311Z
PTAN
CA
Enumeration date
03/21/2007
Last updated
12/28/2015
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