Healthcare Provider Details

I. General information

NPI: 1245211382
Provider Name (Legal Business Name): SAN RAMON PRIMARY CARE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 PORTER DR STE 300
SAN RAMON CA
94583-1587
US

IV. Provider business mailing address

200 PORTER DR STE 300
SAN RAMON CA
94583-1587
US

V. Phone/Fax

Practice location:
  • Phone: 925-838-6500
  • Fax: 925-838-6542
Mailing address:
  • Phone: 925-838-6500
  • Fax: 925-838-6542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS FRANCIS LONG
Title or Position: PRESIDENT, SAN RAMON VALLEY PRIMARY
Credential: MD
Phone: 925-838-6500