Organization
JOHN MUIR TRAUMA PHYSICIAN MEDICAL GROUP
Active
Organization
JOHN MUIR TRAUMA PHYSICIAN MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL MOODY (CHIEF FINANCIAL OFFICER)
(925) 941-2159
Entity
Organization
Contact information
Practice address
1601 YGNACIO VALLEY RD, WALNUT CREEK, CA 94598-3122
(925) 947-5331
(925) 941-2177
Mailing address
1400 TREAT BLVD, 3RD FLOOR, WALNUT CREEK, CA 94597-2142
(925) 947-5331
(925) 941-2177
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0028140
—
CA
Enumeration date
01/10/2007
Last updated
08/22/2020
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