Individual
DR. MICHAEL JAMES MCDERMOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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
G73655
CA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
G73655
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G736550
—
CA
01
—
00G736553
CIGNA DME
CA
01
—
G73655
LICENSE
CA
Enumeration date
11/30/2005
Last updated
10/08/2014
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