Healthcare Provider Details

I. General information

NPI: 1629721196
Provider Name (Legal Business Name): PHYSICIANS MEDICAL HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 ZANKER ROAD
SAN JOSE CA
95131-1115
US

IV. Provider business mailing address

2304 ZANKER ROAD
SAN JOSE CA
95131-1115
US

V. Phone/Fax

Practice location:
  • Phone: 408-937-3600
  • Fax: 408-347-8077
Mailing address:
  • Phone: 408-937-3600
  • Fax: 408-347-8077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER GOLL
Title or Position: CEO
Credential:
Phone: 408-937-3601