Healthcare Provider Details

I. General information

NPI: 1891830881
Provider Name (Legal Business Name): GEOFFREY CASH GURTNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 BLAKE WILBUR DR PLASTIC SURGERY CLINIC
PALO ALTO CA
94304-2201
US

IV. Provider business mailing address

257 CAMPUS DRIVE BLDG PSRL MC 5148 RM GK 201
STANFORD CA
94305-5148
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-7002
  • Fax:
Mailing address:
  • Phone: 650-724-6672
  • Fax: 650-724-9501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA93283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: