Basic Information
| Provider Information | |||||||||
| NPI: | 1700967239 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED ORTHOPAEDIC SURGEONS OF HAYWARD | ||||||||
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| OtherOrganizationName: | ASSOCIATED ORTHOPEDIC SURGEONS | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 N. REDWOOD DRIVE | ||||||||
| Address2: | SUITE 275 | ||||||||
| City: | SAN RAFAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949031968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007040028 | ||||||||
| FaxNumber: | 4153318380 | ||||||||
| Practice Location | |||||||||
| Address1: | 19842 LAKE CHABOT ROAD | ||||||||
| Address2: | |||||||||
| City: | CASTRO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945464002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108868844 | ||||||||
| FaxNumber: | 5108862936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 06/09/2015 | ||||||||
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| AuthorizedOfficialLastName: | POTTORFF | ||||||||
| AuthorizedOfficialFirstName: | GREGG | ||||||||
| AuthorizedOfficialMiddleName: | T. | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5108868844 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | G61064 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.