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Organization

SANTA ROSA SPORTS MEDICINE, INCORPORATED

Active
Other names
Santa Rosa Sports and Family Medicine
Organization subpart
No

Provider details

NPI number
Authorized official
DR. TY PRESTON AFFLECK M.D. (PRESIDENT)
(707) 546-9400
Entity
Organization

Contact information

Practice address
1255 N DUTTON AVE, SANTA ROSA, CA 95401-4663
(707) 546-9400
(707) 546-9464
Mailing address
1255 N DUTTON AVE, SANTA ROSA, CA 95401-4663
(707) 546-9400
(707) 546-9464

Taxonomy

Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
G073843
CA

Other

Enumeration date
11/06/2008
Last updated
10/13/2014
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