Organization
ALEXIS ALEXANDRIDIS MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAROL SHANNON WYCKOFF (ADMINISTRATOR)
(707) 953-9084
Entity
Organization
Contact information
Practice address
246 PERKINS ST, SONOMA, CA 95476-6954
(707) 800-5242
Mailing address
PO BOX 3505, SANTA ROSA, CA 95402-3505
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
C151087
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093925182
NPI - INDIVIDUAL
—
Enumeration date
09/22/2017
Last updated
09/22/2017
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