Provider Demographics
NPI:1154548998
Name:PENINSULA GASTROENTEROLOGY MEDICAL GROUP
Entity type:Organization
Organization Name:PENINSULA GASTROENTEROLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TOROSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-365-3700
Mailing Address - Street 1:2900 WHIPPLE AVE STE 245
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2851
Mailing Address - Country:US
Mailing Address - Phone:650-365-3700
Mailing Address - Fax:
Practice Address - Street 1:853 MIDDLEFIELD RD STE 2
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2919
Practice Address - Country:US
Practice Address - Phone:650-326-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ12647ZMedicare ID - Type Unspecified