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General NPI Number Information
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NPI Number | 1598901340
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Entity Type | Organization
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Legal Business Name | PENINSULA DERMATOLOGIC SURGERY INC
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Dates
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Enumeration Date | 12/29/2008
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Last Update Date | 04/10/2009
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Provider Practice Location Address
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Address Line | 321 MIDDLEFIELD RD # 245
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City | MENLO PARK
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State | CA
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Zip | 94025-3564
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Country | US
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Telephone | 650-326-7222
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Fax | 650-326-7332
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Provider Business Mailing Address
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Address Line | 321 MIDDLEFIELD RD # 245
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City | MENLO PARK
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State | CA
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Zip | 94025-3564
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Country | US
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Telephone | 650-326-7222
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Fax | 650-326-7332
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Authorized Official
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Title or Position | CEO
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Name | DR. JON C. STARR
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Credential | M.D.
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Telephone | 650-326-7222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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