Provider Demographics
NPI:1386701555
Name:PHYSICIANS MEDICAL GROUP OF SAN JOSE INC
Entity type:Organization
Organization Name:PHYSICIANS MEDICAL GROUP OF SAN JOSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-937-3601
Mailing Address - Street 1:2304 ZANKER ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131
Mailing Address - Country:US
Mailing Address - Phone:408-937-3600
Mailing Address - Fax:408-937-3639
Practice Address - Street 1:2304 ZANKER ROAD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131
Practice Address - Country:US
Practice Address - Phone:408-937-3600
Practice Address - Fax:408-937-3639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization