MEDICARE: CHRIS THREATT MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	A79072	CA

General Provider Information

NPI Number	:	1164820320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRIS THREATT MD INC

Provider Business Mailing Address
First Line	:	570 EL CAMINO REAL # 150-446
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-1200
Country	:	US
Telephone Number	:	650-465-6038
Fax Number	:	650-362-9440

Provider Business Practice Location Address
First Line	:	801 BREWSTER AVE STE 240
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94063-1558
Country	:	US
Telephone Number	:	650-465-6038
Fax Number	:	650-362-9440

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JENNIFER PALOMAR
Credential	:
Telephone Number	:	650-207-1272

Provider Enumeration Date	:	12/19/2014
Last Update Date	:	09/14/2023

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Directions to “CHRIS THREATT MD INC ” Practice Location

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