| Ross Valley Medical Corporation | |
|
1000 S. Eliseo Dr. Ste 204 Greenbrae CA 94903 | |
| (415) 461-2262 | |
| (415) 461-9376 |
| Full Name | Ross Valley Medical Corporation |
|---|---|
| Speciality | Family Medicine |
| Location | 1000 S. Eliseo Dr. Ste 204, Greenbrae, California |
| Authorized Official Name and Position | Flash Gordon (OWNER , CEO) |
| Authorized Official Contact | 4154612262 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ross Valley Medical Corporation 1000 S. Eliseo Dr. Ste 204 Greenbrae CA 94904 Ph: (415) 461-2262 | Ross Valley Medical Corporation 1000 S. Eliseo Dr. Ste 204 Greenbrae CA 94903 Ph: (415) 461-2262 |
| NPI Number | 1902852510 |
|---|---|
| Provider Enumeration Date | 05/25/2006 |
| Last Update Date | 12/02/2014 |
| Medicare PECOS PAC ID | 8123080223 |
|---|---|
| Medicare Enrollment ID | O20041101000756 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902852510 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | G37304 (California) | Primary |
| 207R00000X | Internal Medicine | A61715 (California) | Secondary |
| Provider Name | Flash A Gordon |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1982666764 PECOS PAC ID: 6103817002 Enrollment ID: I20040519001645 |
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