Organization
PROSPICE MEDICAL GROUP CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER WILLIAM SHORTZ M.D. (CHIEF EXECUTIVE OFFICER)
(510) 932-6208
Entity
Organization
Contact information
Practice address
4770 N CEDAR AVE, FRESNO, CA 93726-1065
(559) 226-6824
Mailing address
3065 RICHMOND PKWY, SUITE 102, RICHMOND, CA 94806-5719
(510) 932-6208
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
C35999
CA
207T00000X
Neurological Surgery Physician
G10280
CA
207X00000X
Orthopaedic Surgery Physician
A46453
CA
208100000X
Physical Medicine & Rehabilitation Physician
A40212
CA
208VP0000X
Pain Medicine Physician
A77502
CA
Other
Enumeration date
11/23/2007
Last updated
03/30/2008
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