Organization
PLACERVILLE RADIOLOGY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANIETIE OKON MD (PRESIDENT)
(530) 626-2613
Entity
Organization
Contact information
Practice address
1100 MARSHALL WAY, PLACERVILLE, CA 95667-6533
(530) 626-2613
(530) 344-5434
Mailing address
PO BOX 1650, EVANSVILLE, IN 47706-0051
(530) 626-2613
(530) 344-5434
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0053460
—
CA
Enumeration date
03/30/2006
Last updated
03/17/2025
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