Provider Demographics
NPI:1932268109
Name:FAMILY MEDICINE ASSOCIATES OF SAN JOSE INC
Entity type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF SAN JOSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-995-5453
Mailing Address - Street 1:455 OCONNOR DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1632
Mailing Address - Country:US
Mailing Address - Phone:408-995-5453
Mailing Address - Fax:408-275-9442
Practice Address - Street 1:455 OCONNOR DR STE 210
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1632
Practice Address - Country:US
Practice Address - Phone:408-995-5453
Practice Address - Fax:408-275-9442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty