Provider Demographics
NPI:1215573613
Name:TOURO UNIVERSITY MEDICAL GROUP
Entity type:Organization
Organization Name:TOURO UNIVERSITY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:RIEMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:209-645-4005
Mailing Address - Street 1:1805 N CALIFORNIA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6032
Mailing Address - Country:US
Mailing Address - Phone:209-645-4005
Mailing Address - Fax:209-645-6344
Practice Address - Street 1:1805 N CALIFORNIA ST STE 201
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6032
Practice Address - Country:US
Practice Address - Phone:209-645-4005
Practice Address - Fax:209-645-6344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty