Lakeport Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

LAKEPORT MEDICAL GROUP

Practice address

166 D St
Lakeport, CA 95453-5301

Phone

(707) 263-1555

Fax

(707) 262-5810

NPI assigned

Mar 7, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Linda Suzanne Holbrook

Title

Office Manager

Phone

(707) 263-1555

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224028800000",
    "number": "1780714584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 D ST",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954535301",
            "telephone_number": "707-263-1555",
            "fax_number": "707-262-5810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 D ST",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954535301",
            "telephone_number": "707-263-1555",
            "fax_number": "707-262-5810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEPORT MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2008-10-15",
        "status": "A",
        "authorized_official_last_name": "HOLBROOK",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "SUZANNE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "707-263-1555"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "AM567",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lake County Tribal Health Consortium, Inc.
• Lake Dermatology Medical Assoc Inc
• Lake Family Resource Center
• Lakeport County Fire Protection District
• Lakeport Emergency Medical Corporation
• Lakeport Neurology Inc
• Lakeport Physical Therapy, Inc.
• Lakeport Post Acute, LLC
• Lakeport Skilled Nursing Center, Inc.
• Lakeport Unified School District

• Family Medicine Physician in Lakeport, CA
• Providers in Lakeport, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.