Provider Demographics
NPI:1861843955
Name:SUTTER BAY MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:SUTTER BAY MEDICAL FOUNDATION
Other - Org Name:SUTTER PACIFIC MEDICAL FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-450-7357
Mailing Address - Street 1:2350 W EL CAMINO REAL
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6201
Mailing Address - Country:US
Mailing Address - Phone:650-696-5270
Mailing Address - Fax:650-696-5279
Practice Address - Street 1:3880 S BASCOM AVE STE 113
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2600
Practice Address - Country:US
Practice Address - Phone:408-832-5498
Practice Address - Fax:408-927-5421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty