Provider Demographics
NPI:1609430065
Name:GILROY MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:GILROY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:SIAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-206-0217
Mailing Address - Street 1:2222 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-2904
Mailing Address - Country:US
Mailing Address - Phone:408-307-0560
Mailing Address - Fax:
Practice Address - Street 1:8833 MONTEREY RD STE H
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7200
Practice Address - Country:US
Practice Address - Phone:408-842-1544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty