Healthcare Provider Details

I. General information

NPI: 1952340176
Provider Name (Legal Business Name): JAMES L PERTSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 ST.MATTHEWS AVE
SAN MATEO CA
94401-2807
US

IV. Provider business mailing address

104 ST.MATTHEWS AVE
SAN MATEO CA
94401-2807
US

V. Phone/Fax

Practice location:
  • Phone: 650-344-8700
  • Fax: 650-344-8187
Mailing address:
  • Phone: 650-344-8700
  • Fax: 650-344-8187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG62677
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberG62677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: