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General NPI Number Information
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NPI Number | 1053844647
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Entity Type | Organization
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Legal Business Name | STANFORD HEALTH CARE
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 04/10/2017
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Provider Practice Location Address
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Address Line | 1133 E STANLEY BLVD SUITE 111
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City | LIVERMORE
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State | CA
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Zip | 94550-4200
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Country | US
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Telephone | 925-373-4601
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Fax | 925-373-4611
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Provider Business Mailing Address
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Address Line | 1804 EMBARCADERO RD SUITE 100
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City | PALO ALTO
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State | CA
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Zip | 94303-3341
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Country | US
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Telephone | 650-498-5793
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | DAVID CONNOR
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Credential |
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Telephone | 650-725-1074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 070000662
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License Number State | CA
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