Provider Demographics
NPI:1952464943
Name:FREMONT EAT NOSE & THROAT MED GROUP INC
Entity Type:Organization
Organization Name:FREMONT EAT NOSE & THROAT MED GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-797-9999
Mailing Address - Street 1:2557 MOWRY AVE
Mailing Address - Street 2:#30
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-797-9999
Mailing Address - Fax:510-797-9783
Practice Address - Street 1:2557 MOWRY AVE
Practice Address - Street 2:#30
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-797-9999
Practice Address - Fax:510-797-9783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0027800Medicaid
CAGR0027800Medicaid