Provider Demographics
NPI:1487108403
Name:STOCKDALE RADIOLOGY PHYSICIAN SERVICES, INC
Entity type:Organization
Organization Name:STOCKDALE RADIOLOGY PHYSICIAN SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SUADI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:661-631-8000
Mailing Address - Street 1:4000 EMPIRE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0441
Mailing Address - Country:US
Mailing Address - Phone:661-361-8000
Mailing Address - Fax:661-631-8005
Practice Address - Street 1:1020 FRANCISCO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-1127
Practice Address - Country:US
Practice Address - Phone:661-631-8000
Practice Address - Fax:661-631-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty