Healthcare Provider Details

I. General information

NPI: 1447211784
Provider Name (Legal Business Name): JEFFREY STERN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 DWIGHT WAY 2ND FLOOR
BERKELEY CA
94704-2608
US

IV. Provider business mailing address

2001 DWIGHT WAY 2ND FLOOR
BERKELEY CA
94704-2608
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-5745
  • Fax: 510-504-5749
Mailing address:
  • Phone: 510-204-5745
  • Fax: 510-204-5749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberG41447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: