Provider Demographics
NPI:1336448299
Name:JAMES PETROS, M.D., INC.
Entity Type:Organization
Organization Name:JAMES PETROS, M.D., INC.
Other - Org Name:ALLIED PAIN & SPINE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-528-8833
Mailing Address - Street 1:1604 BLOSSOM HILL RD STE 10
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-6350
Mailing Address - Country:US
Mailing Address - Phone:408-528-8833
Mailing Address - Fax:408-528-8557
Practice Address - Street 1:14777 LOS GATOS BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2059
Practice Address - Country:US
Practice Address - Phone:408-528-8833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
CAA90732305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1588322960Medicaid
CA1043830896OtherNPI
CA1598230617Medicaid
CA1326665886Medicaid
CA1568616563Medicaid
CA1184840522Medicaid
CA1194994996Medicaid
CA1831715531Medicaid
CA1174866107Medicaid
CA1043830896Medicaid
CA1205033594Medicaid