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NPI Code Detail

MEDICARE: TERRENCE R DWYRE MD INC

MEDICARE: TERRENCE R DWYRE MD INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianG29689CA

General Provider Information

NPI Number : 1578612842
Entity Type Code : Organization
Provider Name (Legal Business Name) : TERRENCE R DWYRE MD INC
Provider Business Mailing Address
First Line : 393 BLOSSOM HILL ROAD
Second Line : SUITE 210
City : SAN JOSE
State : CA
Zip : 95123-1652
Country : US
Telephone Number : 408-226-5465
Fax Number : 408-226-5466
Provider Business Practice Location Address
First Line : 393 BLOSSOM HILL ROAD
Second Line : SUITE 210
City : SAN JOSE
State : CA
Zip : 95123-1652
Country : US
Telephone Number : 408-226-5465
Fax Number : 408-226-5466
Authorized Official
Title or Position : PRESIDENT
Name : TERRENCE R DWYRE
Credential : MD
Telephone Number : 408-226-5465
Provider Enumeration Date : 01/09/2007
Last Update Date : 12/06/2015

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