Organization
ST. JUDE RADIOLOGY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY A. JACKSON (MEDICAL DIRECTOR / CEO)
(719) 923-3978
Entity
Organization
Contact information
Practice address
215 TIBURON CT, WALNUT CREEK, CA 94597-3437
(714) 992-3978
Mailing address
PO BOX 940, NEWBURY PARK, CA 91319-0940
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Enumeration date
07/12/2017
Last updated
07/12/2017
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