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Organization

GERIATRIC PODIATRY MEDICAL GROUP INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
WILLIAM H TABB DPM (OWNER)
(909) 599-0981
Entity
Organization

Contact information

Practice address
425 W BONITA AVE STE 110, SAN DIMAS, CA 91773-2543
(909) 599-0981
(909) 592-0738
Mailing address
425 W BONITA AVE STE 110, SAN DIMAS, CA 91773-2543
(909) 599-0981
(909) 592-0738

Taxonomy

Speciality
Code
Description
License number
State
213EP0504X
Public Medicine Podiatrist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CJ3207
PALMETTO GBA
CA
05
GRE000050
CA
05
GRE000052
CA
Enumeration date
11/29/2006
Last updated
12/16/2014
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