| Ptr Sports, A Medical Corporation | |
|
1825 Civic Center Dr Suite 25 Santa Clara CA 95050-7301 | |
| (408) 404-4700 | |
| (408) 404-4701 |
| Full Name | Ptr Sports, A Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 1825 Civic Center Dr, Santa Clara, California |
| Authorized Official Name and Position | Jeffrey G Blue (PRESIDENT) |
| Authorized Official Contact | 4084044700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ptr Sports, A Medical Corporation 1825 Civic Center Dr Suite 25 Santa Clara CA 95050-7301 Ph: (408) 404-4700 | Ptr Sports, A Medical Corporation 1825 Civic Center Dr Suite 25 Santa Clara CA 95050-7301 Ph: (408) 404-4700 |
| NPI Number | 1083750764 |
|---|---|
| Provider Enumeration Date | 01/29/2007 |
| Last Update Date | 10/28/2008 |
| Medicare PECOS PAC ID | 5193712651 |
|---|---|
| Medicare Enrollment ID | O20040427001018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083750764 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Primary |
| Provider Name | Jeffrey Glantz Blue |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801900220 PECOS PAC ID: 7517954084 Enrollment ID: I20040507000711 |
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