Healthcare Provider Details

I. General information

NPI: 1194994996
Provider Name (Legal Business Name): JAMES PETROS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 ABORN RD
SAN JOSE CA
95121-1204
US

IV. Provider business mailing address

2724 ABORN RD
SAN JOSE CA
95121-1204
US

V. Phone/Fax

Practice location:
  • Phone: 408-528-8833
  • Fax: 408-528-8557
Mailing address:
  • Phone: 408-528-8833
  • Fax: 408-528-8557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA90732
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA90732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: