Healthcare Provider Details

I. General information

NPI: 1790004703
Provider Name (Legal Business Name): JAMES E GAYDOS DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 ELM STREET SUITE 1
MONTPELIER VT
05602-2868
US

IV. Provider business mailing address

2900 CAMINO DIABLO STE 200
WALNUT CREEK CA
94597-3993
US

V. Phone/Fax

Practice location:
  • Phone: 802-224-9914
  • Fax: 802-224-9014
Mailing address:
  • Phone: 925-464-2100
  • Fax: 925-464-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES EDWARD GAYDOS
Title or Position: PRESIDENT
Credential: DO
Phone: 925-464-2100