Provider Demographics
NPI:1558434589
Name:PENINSULA GASTROENTEROLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:PENINSULA GASTROENTEROLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TOROSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-365-3700
Mailing Address - Street 1:2900 WHIPPLE AVE STE 245
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2851
Mailing Address - Country:US
Mailing Address - Phone:650-365-3700
Mailing Address - Fax:650-368-3836
Practice Address - Street 1:2900 WHIPPLE AVE STE 245
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2851
Practice Address - Country:US
Practice Address - Phone:650-365-3700
Practice Address - Fax:650-368-3836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0025350Medicaid
CAZZZ12647ZOtherBLUE SHIELD
CAZZZ12647ZOtherBLUE SHIELD