Provider Demographics
NPI:1932310372
Name:ALAMEDA FAMILY PHYSICIANS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:ALAMEDA FAMILY PHYSICIANS MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CARPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-521-2300
Mailing Address - Street 1:2433 CENTRAL AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6562
Mailing Address - Country:US
Mailing Address - Phone:510-521-2300
Mailing Address - Fax:510-521-2748
Practice Address - Street 1:2433 CENTRAL AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-6562
Practice Address - Country:US
Practice Address - Phone:510-521-2300
Practice Address - Fax:510-521-2748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP6323208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN
CAZZZ11561ZMedicare ID - Type Unspecified