Provider Demographics
NPI:1790004703
Name:JAMES E GAYDOS DO PC
Entity Type:Organization
Organization Name:JAMES E GAYDOS DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GAYDOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:925-464-2100
Mailing Address - Street 1:2900 CAMINO DIABLO
Mailing Address - Street 2:STE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-3993
Mailing Address - Country:US
Mailing Address - Phone:925-464-2100
Mailing Address - Fax:925-464-2110
Practice Address - Street 1:153 ELM STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2868
Practice Address - Country:US
Practice Address - Phone:802-224-9914
Practice Address - Fax:802-224-9014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0016302OtherMEDICARE PTAN
1790004703OtherNPI