Organization
SANTA ROSA ORTHOPAEDIC MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA BROPHY (PRACTICE MANAGER)
(707) 546-1922
Entity
Organization
Contact information
Practice address
1405 MONTGOMERY DR, SANTA ROSA, CA 95405-4557
(707) 546-1922
(707) 546-1897
Mailing address
1405 MONTGOMERY DR, SANTA ROSA, CA 95405-4557
(707) 546-1922
(707) 546-1897
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
207XX0801X
Orthopaedic Trauma Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
225100000X
Physical Therapist
—
—
225XH1200X
Hand Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0166366
DEPT OF LABOR WASH STATE
CA
01
—
1518907336
NPI
—
01
—
379618500
US DEPT OF LABOR (OWCP)
CA
05
—
GR0012520
—
CA
01
—
ZZZ92332Z
BLUE SHIELD GRP # 1405
CA
Enumeration date
06/08/2006
Last updated
07/14/2023
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