Basic Information
| Provider Information | |||||||||
| NPI: | 1154700169 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED SURGEONS OF HAYWARD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 N REDWOOD DR | ||||||||
| Address2: | SUITE 275 | ||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949031972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4153318390 | ||||||||
| FaxNumber: | 4153318380 | ||||||||
| Practice Location | |||||||||
| Address1: | 19842 LAKE CHABOT RD | ||||||||
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| City: | CASTRO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945464002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108868844 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2015 | ||||||||
| LastUpdateDate: | 05/22/2015 | ||||||||
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| AuthorizedOfficialLastName: | POTTORFF | ||||||||
| AuthorizedOfficialFirstName: | GREGG | ||||||||
| AuthorizedOfficialMiddleName: | THOMAS | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5108868844 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | G61064 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.