Healthcare Provider Details

I. General information

NPI: 1134279904
Provider Name (Legal Business Name): PA MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 SAMARITAN DR SUITE 830
SAN JOSE CA
95124-4100
US

IV. Provider business mailing address

2577 SAMARITAN DR SUITE 830
SAN JOSE CA
95124-4100
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-1319
  • Fax: 408-356-6296
Mailing address:
  • Phone: 408-356-1319
  • Fax: 408-356-6296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: BRYAN J DRUCKER
Title or Position: CEO
Credential: MD
Phone: 408-356-1319