Healthcare Provider Details

I. General information

NPI: 1144332859
Provider Name (Legal Business Name): STUART MARTIN WEISMAN, MD, IN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WELCH RD SUITE 105
PALO ALTO CA
94304-1805
US

IV. Provider business mailing address

900 WELCH RD SUITE 105
PALO ALTO CA
94304-1805
US

V. Phone/Fax

Practice location:
  • Phone: 650-322-2900
  • Fax: 650-322-2904
Mailing address:
  • Phone: 650-322-2900
  • Fax: 650-322-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberG57035
License Number StateCA

VIII. Authorized Official

Name: DR. STUART MARTIN WEISMAN
Title or Position: CEO
Credential: MD
Phone: 650-322-2900