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Organization

REDWOOD RADIOLOGY GROUP INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
FRANK E MODIC M.D. (PRESIDENT)
(707) 546-4062
Entity
Organization

Contact information

Practice address
121 SOTOYOME ST, SANTA ROSA, CA 95405-4823
(707) 546-4062
(707) 525-4095
Mailing address
PO BOX 5651, ORANGE, CA 92863-5651
(714) 571-5000
(714) 571-5055

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
ZZZ81615Y
BLUE SHIELD
CA
01
ZZZ81617Y
BLUE SHIELD
CA
01
ZZZ81618Y
BLUE SHIELD
CA
01
ZZZ81619Y
BLUE SHIELD
CA
01
ZZZ81620Y
BLUE SHIELD
CA
Enumeration date
01/21/2014
Last updated
12/23/2020
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