Organization
BRAD A WOLFSON M D A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORIS OLIVIA EBERHARDT CPC, CUC (OFFICE MANAGER)
(760) 320-6005
Entity
Organization
Contact information
Practice address
555 E TACHEVAH DR STE 2, PALM SPRINGS, CA 92262-5750
(760) 320-6005
(760) 323-5786
Mailing address
555 E TACHEVAH DR, SUITE 2 WEST 101, PALM SPRINGS, CA 92262-5750
(760) 320-6005
(760) 323-5786
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
G61080
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G610801
—
CA
01
—
G61080
CA MEDICAL LICENSE
CA
Enumeration date
10/06/2009
Last updated
02/25/2022
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