Healthcare Provider Details

I. General information

NPI: 1689068215
Provider Name (Legal Business Name): ALEX STUDEMEISTER MD INC A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2015
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N BASCOM AVE SUITE 202
SAN JOSE CA
95128-1811
US

IV. Provider business mailing address

105 N BASCOM AVE SUITE 202
SAN JOSE CA
95128-1811
US

V. Phone/Fax

Practice location:
  • Phone: 408-993-1500
  • Fax:
Mailing address:
  • Phone: 408-993-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG57832
License Number StateCA

VIII. Authorized Official

Name: KONDA DUFFY
Title or Position: BILLING MANAGER
Credential:
Phone: 408-323-2312