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General NPI Number Information
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NPI Number | 1902852510
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Entity Type | Organization
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Legal Business Name | ROSS VALLEY MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 1000 S. ELISEO DR. STE 204
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City | GREENBRAE
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State | CA
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Zip | 94903
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Country | US
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Telephone | 415-461-2262
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Fax | 415-461-9376
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Provider Business Mailing Address
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Address Line | 1000 S. ELISEO DR. STE 204
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City | GREENBRAE
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State | CA
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Zip | 94904
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Country | US
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Telephone | 415-461-2262
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Fax | 415-461-9376
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Authorized Official
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Title or Position | OWNER , CEO
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Name | DR. FLASH GORDON
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Credential | M.D.
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Telephone | 415-461-2262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A61715
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | G37304
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License Number State | CA
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