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General NPI Number Information
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NPI Number | 1134279904
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Entity Type | Organization
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Legal Business Name | PA MEDICAL GROUP INC
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 2577 SAMARITAN DR SUITE 830
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City | SAN JOSE
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State | CA
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Zip | 95124-4100
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Country | US
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Telephone | 408-356-1319
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Fax | 408-356-6296
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Provider Business Mailing Address
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Address Line | 2577 SAMARITAN DR SUITE 830
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City | SAN JOSE
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State | CA
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Zip | 95124-4100
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Country | US
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Telephone | 408-356-1319
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Fax | 408-356-6296
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Authorized Official
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Title or Position | CEO
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Name | BRYAN J DRUCKER
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Credential | MD
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Telephone | 408-356-1319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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