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NPI Code Detail

MEDICARE: STEPHEN ANTHONY WELLER MD

MEDICARE:   STEPHEN ANTHONY WELLER  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology PhysicianC34851CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100C348510OTHERCABLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154312890
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN ANTHONY WELLER MD
Provider Business Mailing Address
First Line : 2350 W. EL CAMINO REAL
Second Line : 2ND FLOOR
City : MOUNTAIN VIEW
State : CA
Zip : 94040-6203
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 701 E. EL CAMINO REAL
Second Line :
City : MOUNTAIN VIEW
State : CA
Zip : 94040-2833
Country : US
Telephone Number : 650-934-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 03/16/2016

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