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General NPI Number Information
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NPI Number | 1750446985
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Entity Type | Organization
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Legal Business Name | BAYCARE MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 360 DARDANELLI LANE STE. 2C
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City | LOS GATOS
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State | CA
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Zip | 95032
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Country | US
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Telephone | 408-402-2452
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Fax | 408-370-0330
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Provider Business Mailing Address
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Address Line | 20 S. SANTA CRUZ AVENUE STE. 300
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City | LOS GATOS
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State | CA
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Zip | 95030
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Country | US
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Telephone | 408-402-2452
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Fax | 408-370-0330
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RICHARD BRIAN FOX
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Credential | M.D.
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Telephone | 408-402-2452
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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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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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